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J Am Acad Dermatol. 2018 Dec;79(6):1081-1088. doi: 10.1016/j.jaad.2018.07.008. Epub 2018 Jul 17.

Bullous disorders associated with anti-PD-1 and anti-PD-L1 therapy: A retrospective analysis evaluating the clinical and histopathologic features, frequency, and impact on cancer therapy.

Author information

1
Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.
2
Department of Internal Medicine (Medical Oncology), Yale University School of Medicine, New Haven, Connecticut.
3
Department of Internal Medicine (Medical Oncology), Yale University School of Medicine, New Haven, Connecticut; Department of Urology, Yale University School of Medicine, New Haven, Connecticut.
4
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
5
Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut. Electronic address: jonathan.leventhal@yale.edu.

Abstract

BACKGROUND:

Bullous disorders associated with anti-programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) therapy are increasingly reported and may pose distinct therapeutic challenges. Their frequency and impact on cancer therapy are not well established.

OBJECTIVE:

To evaluate the clinical and histopathologic findings, frequency, and impact on cancer therapy of bullous eruptions due to anti-PD-1/PD-L1 therapy.

METHODS:

We retrospectively reviewed the medical records of patients evaluated by the oncodermatology clinic and consultative service of Yale New Haven Hospital from 2016 to 2018.

RESULTS:

We identified 9 of 853 patients who developed bullous eruptions (∼1%) that were treated with an-PD-1/PD-L1 therapy at our institution during the study period: 7 presented with bullous pemphigoid, 1 presented with bullous lichenoid dermatitis, and 1 presented with linear IgA bullous dermatosis in the context of vancomycin therapy. In all, 8 patients required systemic steroids, 5 required maintenance therapy, and 8 required interruption of immunotherapy. All 9 patients had an initial positive tumor response or stable disease, but 4 went on to develop disease progression.

LIMITATIONS:

This was a retrospective study from a single tertiary care center.

CONCLUSIONS:

Bullous disorders developed in approximately 1% of patients treated with anti-PD-1/PD-L1 therapy at our institution and frequently resulted in interruption of immune therapy and management with systemic corticosteroids and occasionally steroid-sparing agents.

KEYWORDS:

bullous pemphigoid; immunotherapy; medical dermatology; programmed cell death 1; programmed cell death ligand 1

PMID:
30025829
DOI:
10.1016/j.jaad.2018.07.008
[Indexed for MEDLINE]

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