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Anti-PD-1 therapy for melanoma associated with eczema, vitiligo

Anti-programmed cell death-1 therapy for patients with metastatic melanoma was associated with cutaneous adverse events, including lichenoid reactions, eczema and vitiligo, according to recently published study results.

Researchers conducted a prospective and retrospective observational study with unresectable stage IIIC/IV metastatic melanoma treated with Keytruda (pembrolizumab, Merck) or Opdivo (nivolumab, Bristol-Myers Squibb) between May 1, 2012 and Feb. 1, 2015 at Westmead Hospital, Sydney, Australia.

There were 82 patients (52% male; median age, 61 years) eligible for the study, with 34 assessed by a dermatology team. Medical records of all patients not referred for dermatology review were studied. Fifty-one patients had previously been treated with Yervoy (ipilimumab, Bristol-Myers Squibb).

Forty patients (49%) developed new cutaneous adverse events after the anti-programmed cell death (PD)-1 therapy. Lichenoid reaction (n=14), eczema (n-14) and vitiligo (n=12) were the most frequent lesions. Two patients developed all three, while nine patients developed a combination of two.

“An estimated 25% of patients were expected to develop their first lichenoid reactions within 8.3 months, and eczema and vitiligo within 10.3 months of therapy,” the researchers wrote.

Five patients (median age, 73 years) developed squamous cell carcinoma.

“Clinicians need to be aware that immune-related [adverse events] such as lichenoid reaction, eczema and vitiligo are common among patients on anti-PD-1 therapy, and they appear late in their treatment,” the researchers concluded. “Hence, we recommend these patients have access to long-term regular dermatology reviews. Translational studies searching for predictive biomarkers specific to anti-PD-1 associated lichenoid reactions may allow clinicians to use these biomarkers to predict the likelihood of developing immune-related [adverse events] and the treatment response.” – by Bruce Thiel

Disclosure: Hwang reports no relevant financial disclosures. Please see the full study for other researchers’ relevant financial disclosures.