Immune checkpoint inhibitors (ICPis) have revolutionized outcomes in various advanced malignancies. Therapeutic restoration of a robust T-cell response against malignant cells is also at the root of distinct cutaneous immune-related adverse events (cirAEs). As approved indications for ICPis increase and interdisciplinary collaboration with oncology grows, identifying the most common skin toxicities from ICPis, particularly on melanin-rich skin,1 and understanding treatment strategies are increasingly crucial for dermatologists. This brief review highlights common cirAEs and summarizes the latest evidence for interventions.
Around one-third of patients on ICPi monotherapy and threequarters of patients on combination regimens experience cirAEs, which are graded by Common Terminology Criteria for Adverse Events2 (Table 1). Morbilliform dermatoses, pruritus, lichenoid eruptions (Figure 1), psoriasiform dermatitis (Figure 2), and bullous pemphigoid (Figure 3) are frequently seen with immune checkpoint blockade.3 The current treatment recommendations, summarized in Table 1, are based on level III-IV evidence of retrospective descriptive studies and expert consensus.4-6 Although topical and systemic corticosteroids are the mainstay, refractory cases warrant oral retinoids and targeted biologics based on clinical or histopathologic morphology.5-6 Growing evidence proposes that immunotherapies shift cytokine axes systemically, clinically manifesting as cirAEs.7 More data about ICPi antitumor efficacy with concomitant targeted cytokine blockade are needed.
Around one-third of patients on ICPi monotherapy and threequarters of patients on combination regimens experience cirAEs, which are graded by Common Terminology Criteria for Adverse Events2 (Table 1). Morbilliform dermatoses, pruritus, lichenoid eruptions (Figure 1), psoriasiform dermatitis (Figure 2), and bullous pemphigoid (Figure 3) are frequently seen with immune checkpoint blockade.3 The current treatment recommendations, summarized in Table 1, are based on level III-IV evidence of retrospective descriptive studies and expert consensus.4-6 Although topical and systemic corticosteroids are the mainstay, refractory cases warrant oral retinoids and targeted biologics based on clinical or histopathologic morphology.5-6 Growing evidence proposes that immunotherapies shift cytokine axes systemically, clinically manifesting as cirAEs.7 More data about ICPi antitumor efficacy with concomitant targeted cytokine blockade are needed.
