Combined immune therapy grade IV dermatitis in metastatic melanoma
Autor: | Gregory Gaughran, Adrienne Morey, Andrew Miller, Christine Archer, Divyanshu Dua, Desmond Yip, Manreet Randhawa |
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Rok vydání: | 2019 |
Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry medicine.medical_treatment Acute kidney injury Ipilimumab General Medicine medicine.disease Dermatology Rash 03 medical and health sciences 0302 clinical medicine Oncology 030220 oncology & carcinogenesis Biopsy Maculopapular rash Medicine 030212 general & internal medicine Nivolumab medicine.symptom business Adverse effect Dialysis medicine.drug |
Zdroj: | Asia-Pacific Journal of Clinical Oncology. 15:262-265 |
ISSN: | 1743-7555 |
DOI: | 10.1111/ajco.13136 |
Popis: | Checkpoint inhibition is the mainstay of treatment in metastatic melanoma. More recently combined cytotoxic T-lymphocyte antigen-4 and programmed-death-1 blockade has resulted in improved response rates and overall survival in treatment naive patients compared to monotherapy albeit with increased rates of adverse events. Dermatologic toxicities are an emerging consequence of the use of checkpoint inhibitors and have reportedly been more prevalent with the use of combined therapy. However, grade 3 and 4 adverse event rates are still less than 5%. Here, we report a case of a 63-year-old Caucasian male with metastatic melanoma treated with first line combined ipilimumab and nivolumab who then developed a steroid refractory, biopsy confirmed pityriasis lichenoides-like, drug related rash that resolved with cyclosporine. Time of onset was 24 days and presenting symptoms demonstrated a maculopapular rash presenting over the back and chest with pruritus. Unfortunately, the patient subsequently had multi-organ failure with acute kidney injury requiring dialysis, hypotension requiring vasopressor support, hepatic dysfunction, and bilateral lung infiltrates resulting in a fatal outcome. This case report highlights the effective use of cyclosporine as an immunomodulatory agent in the management of severe dermatological toxicity due to combination immunotherapy. |
Databáze: | OpenAIRE |
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