Delayed Immune-Related Erythrodermia in a Squamous NSCLC Patient Treated with Nivoluma

Journal of Cancer Research and Immuno-Oncology is an open access peer reviewed journal in the field of cancer research. Journal of Cancer Research and Immuno-Oncology covers a broad scope for the authors to make their valuable contributions in cancer biology, tumor, radiology, metastatis, cancer immunotherapy, oncology, radiation therapy et

Immunotherapy has been changing the scenario of the treatment of non-small cell lung cancer (NSCLC) and is leading to a dramatic improvement in the clinical outcome of patients suffering from this disease. Immunotherapy has a specific toxicity profile and many oncologists are facing a new challenge in the form of clinical management of immune-related adverse events (irAEs). Even though most irAEs remain mild in intensity, around 10% of patients treated with anti-PD1/anti-PDL1 drugs will develop severe, sometimes life-threatening, dysimmune toxicities.

Skin toxicity is one of the most common irAEs. The irAEs related to skin toxicity can have many different presentations, which includes maculopapular or papulopustular rash, Sweet’s syndrome, follicular or urticarial dermatitis. It typically occurs within 6 weeks from the beginning of the treatment but, due to the mechanism of action of immunotherapic drugs, delayed toxicities are reported. We present a case study of delayed grade 4 skin toxicity in a 75-year-old male patient with stage IV squamous NSCLC treated with Nivolumab.

Skin rash is one of the most common irAEs associate with immune checkpoint monoclonal antibody(mAb) therapy. It typically occurs within six weeks from the onset of the oncological immunotherapy. Нis clinical presentation can range from maculopapular or papulopustular eritemas, Sweet’s syndrome, to follicular or urticarial dermatitis as well. Even if the maculopapular rash is most commonly observed, rarer rashes have been observed, including lichenoid (e.g., lichenoid dermatitis) , and bullous disorders including bullous pemphigoid , Stevens Johnson syndrome, and toxic epidermal necrolysis, which are of special interest due to their severity and potentially life-threatening consequences.

It has been believed that in some cases the mechanism for developing the skin toxicity may be because of blockade of a common antigen, co-expressed on a patient’s tumor cells, and those of the dermo-epidermal junction and/or other levels of the skin. Our case report underlines that each irAEs, while being characterized by its own timing of onset, may occur anytime and even aÑ–er the discontinuation of the immunotherapy. НLs is certainly associated with the mechanism of action of the immunotherapy drug: the activation of the host’s immune system against the tumor is maintained for many weeks aÑ–er the suspension of the treatment. НLs is the reason why we can observe delayed toxicity but also prolonged clinical and radiological benefit from the treatment. Moreover, the use of corticosteroids for the management of irAEs doesn’t compromise the outcome of the treatment.

Нis clinical case we observed underlines the importance of each step of the management of immune-related toxicities, the knowledge of the immune-toxicity spectrum, the identification of the risk factor. Нis correct information of the patients and caregivers are fundamental to promptly identify a potentially serious problem in order to implement the best treatment for each clinical situation.

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