Clinical observation on skin adverse reactions after treatment of programmed cell death protein-1 inhibitors

Abstract

Objective To investigate the occurrence and outcomes of immune-related adverse events (irAEs) in the clinical application of programmed cell death protein 1 (PD-1) inhibitors. Methods A retrospective cohort studies was performed on 456 patients with malignant tumors treated with PD-1 inhibitors from March 2020 to November 2022, and the types, grades and prognosis of adverse skin reactions were observed. Results In the cohort, 101 patients experienced irAEs. There were 71 (70.29%) patients having reactive cutaneous capillary endothelial proliferation (RCCEP), including 15 cases of grade 2 and 56 cases of grade 1, most of whom did not receive special treatment and a small number of whom had hemangioma regression after apatinib treatment; 22 (21.7%) patients developing itchy skin, including 4 cases of grade 2 and 18 cases of grade 1, with the symptoms disappearing within 1 week after topical glucocorticoid and oral antihistamine treatment; 15 (14.8%) patients experiencing maculopapular rash, including 9 cases of grade 1 and 6 cases of grade 2 of skin adverse reactions, which were greatly improved after symptomatic treatment with emollients, topical glucocorticoids and oral antihistamines; 4 (3.9%) cases of vitiligo-like depigmentation, including 1 case of grade 2 and 3 cases of grade 1, all of which did not receive special treatment; 1 case of toxic epidermal necrolysis (TEN), and the skin lesions were improved after ICU supportive therapy and hormonal antibiotic administration; and 1 case of psoriasis at grade 3 skin reaction, and the lesions were improved after intravenous glucocorticoid drugs. Conclusion Among the irAEs events after PD-1 inhibitor treatment, the adverse skin reactions are mainly grade 1~3, and grade 4 or above are rare. After symptomatic treatment of irAEs, most symptoms can be relieved. Early identification and full management of skin adverse events can prevent the deterioration of lesions, and irAEs are generally safe and controllable.

Keywords

• programmed cell death protein 1
• immune checkpoint inhibitors
• cutaneous immune-related adverse events