Chronic Skin Effects Persist After Cancer Immunotherapy

TOPLINE: 

Chronic cutaneous immune-related adverse events (cirAEs) that develop after immune checkpoint inhibitor (ICI) therapy may require long-term follow-up.

METHODOLOGY:

• A cohort study of 318 patients treated with ICIs from 2015 to 2022 identified 100 patients with cirAEs, of which 24 were chronic (persisting more than 3 months after treatment cessation).
• Analysis included 52 total patients (20 women; median age, 66.5 years), of which 21 patients had detailed follow-up and 31 were from Vanderbilt clinics.
• Participants received nivolumab, pembrolizumab, or ipilimumab, with a median treatment duration of 342 days and median follow-up after cessation of 1032 days.

TAKEAWAY:

• Chronic cirAEs developed in 24 patients (8% of the full cohort). Symptoms resolved in 41 patients (79%) during follow-up, but 41 (79%) still had reactions at 12 months and 28 (54%) at 18 months.
• Among the 52 patients, 85% experienced grades 1 to 2 cirAEs, while 14% developed grade 3 reactions, most commonly pruritus, morbilliform eruptions, and dermatitis.
• Patients with dermatologic follow-up (27 patients) showed higher-grade cirAEs (grade 3, 46%) and more frequent biologics use (33%) than those without follow-up (14% and 0%, respectively).
• The median duration of chronic cirAEs was 629 days, with a median duration after ICI discontinuation of 446 days.

IN PRACTICE:

“Chronic cirAEs occurred in nearly 25% of patients with cirAEs,” the authors wrote. They suggested that long-term follow-up with dermatologists familiar with treating cirAEs can help in “effective diagnosis and consideration of corticosteroid-sparing treatment options.”

SOURCE:

The study was led by Douglas B. Johnson, MD, MSCI, Vanderbilt University Medical Center in Nashville, Tennessee. It was published online on March 12 in JAMA Dermatology.

LIMITATIONS:

The cohort comprised more severe cases seen by dermatologists, potentially skewing the findings. Patients without dermatologic follow-up may have had distinct presentations and management strategies.

DISCLOSURES:

The study was supported by Vanderbilt University School of Medicine, the National Health and Medical Research Council, the University of Sydney Medical Foundation, the National Cancer Institute, James C. Bradford Melanoma Fund, and the Van Stephenson Melanoma Fund. One author reported receiving funding from Medical Scholars at Vanderbilt University School of Medicine during the conduct of the study. Other authors also received personal fees and grants from various organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.