Frontiers in Medicine (Jul 2023)
Autoimmune bullous dermatoses in cancer patients treated by immunotherapy: a literature review and Italian multicentric experience
- Martina Merli,
- Martina Accorinti,
- Maurizio Romagnuolo,
- Maurizio Romagnuolo,
- Angelo Marzano,
- Angelo Marzano,
- Giovanni Di Zenzo,
- Francesco Moro,
- Emiliano Antiga,
- Roberto Maglie,
- Emanuele Cozzani,
- Emanuele Cozzani,
- Aurora Parodi,
- Aurora Parodi,
- Giulia Gasparini,
- Giulia Gasparini,
- Pietro Sollena,
- Clara De Simone,
- Clara De Simone,
- Marzia Caproni,
- Luigi Pisano,
- Davide Fattore,
- Riccardo Balestri,
- Paolo Sena,
- Pamela Vezzoli,
- Miriam Teoli,
- Marco Ardigò,
- Camilla Vassallo,
- Andrea Michelerio,
- Andrea Michelerio,
- Rosanna Rita Satta,
- Emi Dika,
- Emi Dika,
- Barbara Melotti,
- Simone Ribero,
- Pietro Quaglino
Affiliations
- Martina Merli
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
- Martina Accorinti
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
- Maurizio Romagnuolo
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Maurizio Romagnuolo
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
- Angelo Marzano
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Angelo Marzano
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
- Giovanni Di Zenzo
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
- Francesco Moro
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
- Emiliano Antiga
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
- Roberto Maglie
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
- Emanuele Cozzani
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Emanuele Cozzani
- Dermatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Aurora Parodi
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Aurora Parodi
- Dermatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Giulia Gasparini
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Giulia Gasparini
- Dermatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Pietro Sollena
- Dermatology Unit, Department of Surgical and Medical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Clara De Simone
- Dermatology Unit, Department of Surgical and Medical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Clara De Simone
- Dermatology Unit, University Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, Rome, Italy
- Marzia Caproni
- 0Immunopathology and Rare Skin Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda Unità Sanitaria Locale Toscana Centro, University of Florence, Florence, Italy
- Luigi Pisano
- 1Section of Dermatology, Department of Health Sciences, Azienda Unità Sanitaria Locale Toscana Centro, University of Florence, Florence, Italy
- Davide Fattore
- 2Section of Dermatology, Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli Federico II, Naples, Italy
- Riccardo Balestri
- 3Division of Dermatology, Outpatient Consultation for Rare Diseases, APSS, Trento, Italy
- Paolo Sena
- 4Dermatology Unit ASST-Papa Giovanni XXIII, Bergamo, Italy
- Pamela Vezzoli
- 4Dermatology Unit ASST-Papa Giovanni XXIII, Bergamo, Italy
- Miriam Teoli
- 5Porphyria and Rare Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
- Marco Ardigò
- 5Porphyria and Rare Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
- Camilla Vassallo
- 6Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Andrea Michelerio
- 7Dermatology Unit, Ospedale Cardinal Massaia, Asti, Italy
- Andrea Michelerio
- 8Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Rosanna Rita Satta
- 9Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy
- Emi Dika
- 0Melanoma Center, Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Emi Dika
- 1Unit of Dermatology, Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Barbara Melotti
- 2Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Simone Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
- Pietro Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
- DOI
- https://doi.org/10.3389/fmed.2023.1208418
- Journal volume & issue
-
Vol. 10
Abstract
Cutaneous immune-related adverse events are frequently associated with immune checkpoint inhibitors (ICIs) administration in cancer patients. In fact, these monoclonal antibodies bind the cytotoxic T-lymphocyte antigen-4 and programmed cell death-1/ligand 1 leading to a non-specific activation of the immune system against both tumoral cells and self-antigens. The skin is the most frequently affected organ system appearing involved especially by inflammatory manifestations such as maculopapular, lichenoid, psoriatic, and eczematous eruptions. Although less common, ICI-induced autoimmune blistering diseases have also been reported, with an estimated overall incidence of less than 5%. Bullous pemphigoid-like eruption is the predominant phenotype, while lichen planus pemphigoides, pemphigus vulgaris, and mucous membrane pemphigoid have been described anecdotally. Overall, they have a wide range of clinical presentations and often overlap with each other leading to a delayed diagnosis. Achieving adequate control of skin toxicity in these cases often requires immunosuppressive systemic therapies and/or interruption of ICI treatment, presenting a therapeutic challenge in the context of cancer management. In this study, we present a case series from Italy based on a multicenter, retrospective, observational study, which included 45 patients treated with ICIs who developed ICI-induced bullous pemphigoid. In addition, we performed a comprehensive review to identify the cases reported in the literature on ICI-induced autoimmune bullous diseases. Several theories seeking their underlying pathogenesis have been reported and this work aims to better understand what is known so far on this issue.
Keywords
