Date of Award
Open Access Thesis
Medical Doctor (MD)
Jonathan S. Leventhal
Immune checkpoint inhibitors (ICI) have been associated with a multitude of immune-related adverse events (irAE), which affect multiple organ systems in the setting of increased immune activation. Cutaneous immune-related adverse events (cirAE) are among the most common irAE, occurring in up to 50% of patients treated with an ICI. The most common cirAE are maculopapular eruption, pruritus (with or without primary cutaneous eruption), lichenoid dermatitis, eczematous dermatitis, psoriasiform eruption, and vitiligo. cirAE are of concern to oncologists and dermatologists alike, as cirAE can necessitate interruption or discontinuation of life-prolonging therapy. There is a paucity of data regarding cirAE in specific patient populations, including patients with skin of color (SOC) and patients with a prior dermatologic diagnosis.
Our primary aim was to characterize the spectrum of ICI-induced cirAE diagnosed and treated by the Yale Oncodermatology Clinic. Our second aim was to characterize cirAE among patients with SOC who were diagnosed and treated by the Yale Oncodermatology Clinic. Our third aim was to characterize cirAE among patients with a history of psoriasis or eczema who were diagnosed and treated by the Yale Oncodermatology Clinic.
This retrospective case series included all patients treated with an ICI who were referred to the Yale Oncodermatology Clinic for cirAE. Patients seen for any concern other than cirAE were not included within this cohort. Data collection was performed manually due to lack of appropriate International Classification of Diseases 10th Revision (ICD-10) codes for cirAE. All data was entered into a secure REDCap database. Descriptive analyses and chi-square tests were performed using SPSS Statistics.
Aim 1: 287 patients were treated by the Yale Oncodermatology Clinic for cirAE. Within this cohort, mean age was 66 (SD 11), 53% of patients were male, and the most common oncologic diagnoses were non-small cell lung cancer (33%), melanoma (22%), and renal cell carcinoma (8.7%). 338 cirAE were reported, of which the most frequently observed were lichenoid dermatitis (18%) and eczematous dermatitis (15%).
Aim 2: Of patients treated by the Yale Oncodermatology Clinic, 31 were included in the SOC cohort based on demographic data. The most common cirAE observed in this cohort were lichenoid dermatitis (22%) and eczematous dermatitis (22%).
Aim 3: Of patients treated by the Yale Oncodermatology Clinic, 11 had a history of eczema and 18 had a history of psoriasis. Those with a history of eczema were significantly more likely to develop eczematous dermatitis than controls (43%, versus 12%) and those with a history of psoriasis were significantly more likely to develop psoriasiform dermatitis than controls (56%, versus 6.1%).
As ICI become a cornerstone of oncologic therapy, it is critical that the presentation and treatment of cirAE in various patient populations are integrated into dermatologic training.
Belzer, Annika, "Characterization Of Cutaneous Immune-Related Adverse Events Due To Immune Checkpoint Inhibitors" (2023). Yale Medicine Thesis Digital Library. 4169.
This Article is Open Access