Immune Toxicity with Checkpoint Inhibition for Metastatic Melanoma: Case Series and Clinical Management
Joint Authors
Lomax, Anna J.
Lim, Jennifer
Cheng, Robert
Sweeting, Arianne
Lowe, Patricia
McGill, Neil
Shackel, Nicholas
McNeil, Catriona
Chua, Elizabeth
Source
Issue
Vol. 2018, Issue 2018 (31 Dec. 2018), pp.1-13, 13 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2018-01-21
Country of Publication
Egypt
No. of Pages
13
Main Subjects
Abstract EN
Immune checkpoint inhibitors (anti-PD-1 and anti-CTLA-4 antibodies) are a standard of care for advanced melanoma.
Novel toxicities comprise immune-related adverse events (irAE).
With increasing use, irAE require recognition, practical management strategies, and multidisciplinary care.
We retrospectively evaluated the incidence, kinetics, and management of irAE in 41 patients receiving anti-PD-1 antibody therapy (pembrolizumab) for advanced melanoma.
63% received prior anti-CTLA-4 antibody therapy (ipilimumab).
IrAE occurred in 54%, most commonly dermatological (24%), rheumatological (22%), and thyroid dysfunction (12%).
Thyroiditis was characterised by a brief asymptomatic hyperthyroid phase followed by a symptomatic hypothyroid phase requiring thyroxine replacement.
Transplant rejection doses of methylprednisolone were necessary to manage refractory hepatotoxicity.
A bullous pemphigoid-like skin reaction with refractory pruritus responded to corticosteroids and neuropathic analgesia.
Disabling grade 3-4 oligoarthritis required sulfasalazine therapy in combination with steroids.
The median interval between the last dose of anti-CTLA-4 antibody and the first dose of anti-PD-1 therapy was 2.0 months (range: 0.4 to 22.4).
Toxicities may occur late; this requires vigilance and multidisciplinary management which may allow effective anticancer therapy to continue.
Management algorithms for thyroiditis, hypophysitis, arthralgia/arthritis, colitis, steroid-refractory hepatitis, and skin toxicity are discussed.
American Psychological Association (APA)
Lomax, Anna J.& Lim, Jennifer& Cheng, Robert& Sweeting, Arianne& Lowe, Patricia& McGill, Neil…[et al.]. 2018. Immune Toxicity with Checkpoint Inhibition for Metastatic Melanoma: Case Series and Clinical Management. Journal of Skin Cancer،Vol. 2018, no. 2018, pp.1-13.
https://search.emarefa.net/detail/BIM-1202353
Modern Language Association (MLA)
Lomax, Anna J.…[et al.]. Immune Toxicity with Checkpoint Inhibition for Metastatic Melanoma: Case Series and Clinical Management. Journal of Skin Cancer No. 2018 (2018), pp.1-13.
https://search.emarefa.net/detail/BIM-1202353
American Medical Association (AMA)
Lomax, Anna J.& Lim, Jennifer& Cheng, Robert& Sweeting, Arianne& Lowe, Patricia& McGill, Neil…[et al.]. Immune Toxicity with Checkpoint Inhibition for Metastatic Melanoma: Case Series and Clinical Management. Journal of Skin Cancer. 2018. Vol. 2018, no. 2018, pp.1-13.
https://search.emarefa.net/detail/BIM-1202353
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1202353