Immune checkpoint inhibitor-related dermatologic adverse events.
Immune checkpoint inhibitor-related dermatologic adverse events.
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DOI：
10.1016/j.jaad.2020.03.132
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发表时间：
2020-11
影响因子：
13.8
通讯作者：
Lacouture ME
中科院分区：
文献类型：
--
作者：
Geisler AN;Phillips GS;Barrios DM;Wu J;Leung DYM;Moy AP;Kern JA;Lacouture ME
免疫检查点抑制剂已成为晚期恶性肿瘤管理的支柱。然而，非特异性免疫激活可能导致免疫相关的不良事件，其中皮肤及其附件是最常见的靶点。皮肤免疫相关不良事件包括一组不同的炎症反应，斑丘疹、瘙痒、银屑病样和苔藓样皮疹是最常见的亚型。皮肤免疫相关不良事件发生较早，斑丘疹在初始免疫检查点抑制剂剂量后的前6周内出现。管理包括使用局部皮质类固醇治疗轻度至中度（1-2级）皮疹，添加全身皮质类固醇治疗重度（3级）皮疹，并停止免疫治疗4级皮疹。大疱性类天疱疮皮疹、白癜风样皮肤色素减退/色素脱失和银屑病样皮疹通常归因于程序性细胞死亡-1/程序性细胞死亡配体-1抑制剂。大疱性类天疱疮出疹的治疗与斑丘疹和苔藓样出疹的治疗相似，3-4级皮疹加用利妥昔单抗。除光防护措施外，皮肤色素减退/脱色不需要特殊的皮肤病学治疗。除外用皮质类固醇外，银屑病样皮疹可使用维生素D3类似物、窄带紫外线B光疗法、类维生素A或免疫调节生物制剂治疗。StevenseJohnson综合征和其他严重的皮肤免疫相关不良事件虽然罕见，但也与检查点阻断相关，需要住院治疗以及紧急皮肤科咨询。
Immune checkpoint inhibitors have emerged as a pillar in the management of advanced malignancies. However, nonspecific immune activation may lead to immune-related adverse events, wherein the skin and its appendages are the most frequent targets. Cutaneous immune-related adverse events include a diverse group of inflammatory reactions, with maculopapular rash, pruritus, psoriasiform and lichenoid eruptions being the most prevalent subtypes. Cutaneous immune-related adverse events occur early, with maculopapular rash presenting within the first 6 weeks after the initial immune checkpoint inhibitor dose. Management involves the use of topical corticosteroids for mild to moderate (grades 1–2) rash, addition of systemic corticosteroids for severe (grade 3) rash, and discontinuation of immunotherapy with grade 4 rash. Bullous pemphigoid eruptions, vitiligo-like skin hypopigmentation/depigmentation, and psoriasiform rash are more often attributed to programmed cell death-1/programmed cell death ligand-1 inhibitors. The treatment of bullous pemphigoid eruptions is similar to the treatment of maculopapular rash and lichenoid eruptions, with the addition of rituximab in grade 3–4 rash. Skin hypopigmentation/depigmentation does not require specific dermatologic treatment aside from photoprotective measures. In addition to topical corticosteroids, psoriasiform rash may be managed with vitamin D3 analogues, narrowband ultraviolet B light phototherapy, retinoids, or immunomodulatory biologic agents. StevenseJohnson syndrome and other severe cutaneous immune-related adverse events, although rare, have also been associated with checkpoint blockade and require inpatient care as well as urgent dermatology consultation.
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DOI：
10.1016/s1470-2045(16)30053-5
发表时间：
2016-07
期刊：
The Lancet. Oncology
影响因子：
--
作者：
Goldberg SB;Gettinger SN;Mahajan A;Chiang AC;Herbst RS;Sznol M;Tsiouris AJ;Cohen J;Vortmeyer A;Jilaveanu L;Yu J;Hegde U;Speaker S;Madura M;Ralabate A;Rivera A;Rowen E;Gerrish H;Yao X;Chiang V;Kluger HM
通讯作者：
Kluger HM
影响因子：
6.2
作者：
Faje, Alexander T.;Lawrence, Donald;Sullivan, Ryan J.
通讯作者：
Sullivan, Ryan J.
影响因子：
50.5
作者：
Champiat, S.;Lambotte, O.;Marabelle, A.
通讯作者：
Marabelle, A.
影响因子：
51.1
作者：
Antonia, Scott J.;Lopez-Martin, Jose A.;Calvo, Emiliano
通讯作者：
Calvo, Emiliano
影响因子：
7.2
作者：
Ali, Omar Hasan;Diem, Stefan;Flatz, Lukas
通讯作者：
Flatz, Lukas