Some cancer patients experience durable remissions from immune checkpoint inhibitors that spur their T cells to attack cancer cells, but these immunotherapies can also cause reactions.

One of the adverse effects of these treatments is skin reactions known as cutaneous immune-related adverse events (cirAEs), although it is not known how often they morph into a chronic condition. Research led by investigators at Vanderbilt University Medical Center published in JAMA Dermatology provides insight into chronic cirAEs. They recommended long-term follow-up for patients by dermatologists familiar with cirAEs and consideration of corticosteroid-sparing treatment options.

“Understanding the potential for side effects to become long-lasting has been an important advance recently, and managing them more effectively is a key unmet need,” said the study’s corresponding author, Douglas Johnson, MD, MSCI, professor of Medicine, holder of the Susan and Luke Simons Directorship, and co-leader of the Translational Research and Interventional Oncology Research Program at Vanderbilt-Ingram Cancer Center.

The investigators reviewed the records of 318 patients from a previous study who had been treated with immune checkpoint inhibitors. Of that number, 100 or 31% developed cirAEs with the skin conditions becoming chronic for 24 of the patients — nearly 8% of the full cohort. The study looked at 21 of those patients who underwent detailed follow-up. Another 31 patients were added from Vanderbilt clinics who were treated for cirAEs.

The 52 patients had received either pembrolizumab, nivolumab, ipilimumab or anti-PD1 and CTLA4 combination therapy.

The types of skin reactions varied, with 15 experiencing pruritus or itchy skin, 12 experienced morbilliform eruptions or drug-induced skin rashes, 12 experienced dermatitis or inflamed and scaly rashes, eight experienced bullous pemphigoid-like eruptions (fluid-filled blisters that resemble a rare autoimmune skin disease), five experienced eczema, four experienced lichenoid (flat-topped, scaly lesions), two experienced psoriasiform (breakouts that resemble psoriasis), and one experienced acneiform or acne-like eruptions.

The median duration of cirAE from treatment cessation was 446 days. Rare cases lasted more than five years.

Other Vanderbilt authors on the study included the study’s lead author, Kylie Fletcher, BS, Rachel Goodman, MD, MBA, J. Randall Patrinely, MD, MBA, and Anna Dewan, MD, MHS.

The research received support from Medical Scholars at Vanderbilt University School of Medicine, the Susan and Luke Simons Directorship, the James C. Bradford Jr. Fund in Melanoma Cancer Research and the Van Stephenson Memorial Cancer Research Fund.

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Vanderbilt researchers are working to better design immune therapies that attack tumors without also attacking healthy normal tissue in patients.