IL17A Blockade Successfully Treated Psoriasiform Dermatologic Toxicity from Immunotherapy
IL17A Blockade Successfully Treated Psoriasiform Dermatologic Toxicity from Immunotherapy
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DOI：
10.1158/2326-6066.cir-18-0682
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发表时间：
2019-06-01
影响因子：
10.1
通讯作者：
Diab, Adi
中科院分区：
文献类型：
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作者：
Johnson, Daniel;Patel, Anisha B.;Diab, Adi
皮肤病毒性是仅次于免疫检查点抑制剂(ICI)的最常见的免疫相关不良事件(IRAE)。3级或4级皮肤irAEs的一线治疗是大剂量皮质类固醇，它们有自己的副作用。长期使用皮质类固醇治疗可能会消除抗肿瘤ICI活性。这些皮肤病毒性的细胞原因，可表现为各种临床表现，目前尚不清楚。除了类固醇外，推荐的治疗选择是有限的。我们报告了一例银屑病样皮肤病毒性，由pembrolizumab单抗抑制PD-1引起，经全身白介素IL17A阻断治疗后缓解。引入IL17A阻滞剂并没有改变患者对培溴利珠单抗的黑色素瘤反应。此病例提示转移性黑色素瘤患者皮肤中Th17细胞可能起致病作用。
Dermatologic toxicities are the most common immune-related adverse events (irAE) secondary to immune checkpoint inhibitors (ICI). First-line treatment for grade 3 or 4 skin irAEs is high-dose corticosteroids, which have their own side effects. Prolonged treatment with corticosteroids may abrogate antitumor ICI activity. The cellular causes of these dermatologic toxicities, which can manifest as a variety of clinical presentations, remain unclear. Beyond steroids, recommended treat-ment options are limited. We report a case of psoriasiform dermatologic toxicity, induced by inhibition of PD-1 with the mAb pembrolizumab, which resolved after treatment with systemic interleukin IL17A blockade. Introduction of IL17A blockade did not alter the patient's melanoma response to pembrolizumab. This case suggests a possible pathogenic role of Th17 cells the irAE of the skin in this metastatic melanoma patient.