Management of immune-related cutaneous adverse events with dupilumab

Immune system delivery of antitumor effects is made possible by immune checkpoint inhibitors ( ICI ), which target the PD – 1 / PD L1 and CTLA – 4 pathways. However, it is also linked to well-recognized immune-related cutaneous adverse events( ircAEs ), which can affect up to 90 % of ICI patients. In this study, we discuss the traits and patient outcomes of ircAEs that have been treated with dupilumab and are ICI-associated steroid-refractory or dependent on steroids. This retrospective study, which evaluated the rate of clinical response of the ircAE to dupilumab and any associated adverse events( AEs ), included patients with the disease between March 28, 2017, and October 1, 2021, at Memorial Sloan Kettering Cancer Center. Before and after dupilumab, laboratory values were compared. A dermatopathologist reviewed every available biopsy of the ircAEs. 34 out of 39 patients( 77 %, 95 % CI: 73 % to 96 %) responded to dupilumab. 15 ( 44.1 %) of these 34 respondents were full responders with a total ircAE resolution, and 19 ( 55.9 %) had partial responses with appreciable clinical improvement or severity reduction. Only one patient( 2.6 %) stopped receiving treatment because of AEs, specifically the injection site reaction. The average eosinophil count fell by 0. 2 K / mcL( p = 0.0086 ). By a mean of 2.6 %( p = 0.0152 ), relative eosinophils decreased. The average decrease in serum immunoglobulin E levels was 372.1 kU / L( p = 0.0728 ). Spongiotic dermatitis( n = 13, 33.3 %) and interface skin irritation ( sn = 5, 12.8 %) were the two primary inflammatory patterns that were most frequently detected on histopathological examination. For immune-related or steroid-dependent cutaneous adverse events, particularly those that are eczematous, maculopapular, or pruritic, dupilumab is a promising option. Dupilumab was well-tolerated and had a high overall response rate among this cohort. However, prospective, randomized, and controlled trials are necessary to verify these findings and the safety of the product over the long term.

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Categorized as Oncology

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