Exacerbation of pre-existence psoriasis following immune checkpoint inhibitor treatment

Yoko Minokawa MD, Yu Sawada MD, PhD
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引用次数: 1

Abstract

Immune checkpoint inhibitors are currently developed for the treatment of cancers showing high efficacy even in the cases of advanced and persistent malignancies. Psoriasis has been reported as a rare irAE in both the exacerbation of preexisting psoriasis and the novel onset psoriasis during immunotherapy. Herein, we report a case of pre-existence psoriasis, which was exacerbated following the administration of immune checkpoint inhibitors. We also summarize case reports and conducted a review of the literature.

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免疫检查点抑制剂治疗后原发性银屑病加重
免疫检查点抑制剂(ICI)目前被开发用于治疗癌症,即使在晚期和持续性恶性肿瘤的情况下也显示出很高的疗效。1相反,在ICI治疗过程中,自身免疫性不良反应是公认的。2皮肤耐受性的抑制会加剧过度炎症反应,3而ICI治疗会削弱皮肤耐受机制。4,5事实上,皮肤毒性是最常见的免疫检查点抑制剂相关不良事件(irAE)之一,如斑丘疹、苔藓样皮炎、大疱性天疱疮和白癜风。6在免疫治疗过程中,银屑病也被报道为一种罕见的irAE,既有既往银屑病的恶化,也有新发银屑病的恶化。然而,这些差异的具体特征尚不清楚。在此,我们报告了一例既往银屑病,在给予ICI后病情加重。我们还总结了病例报告,并对文献进行了回顾。一名63岁的男性患有晚期肾透明细胞癌,在伊普利姆单抗80 mg加尼沃单抗240 mg的4个免疫治疗周期后,每2周接受一次尼沃单抗240mg的治疗。在出现时,该治疗已进行了5次。尽管他在服用ICI前5年患有慢性斑块型银屑病,但他的银屑病在没有任何治疗的情况下得到了控制。体格检查显示,他的躯干和四肢普遍分布有鳞状红斑丘疹和斑块。皮肤活检显示角化不全伴棘皮病,表皮有鳞状下层。在乳头状真皮中也观察到淋巴细胞浸润。根据临床表现和组织学检查,诊断为寻常型银屑病。在nivolumab治疗下,他的皮肤出疹对局部皮质类固醇和维生素D类似物反应良好。ipilimumab联合nivolumab免疫治疗4个周期后,肿瘤大小缩小。然而,在给予ICI后8个月观察到肿瘤进展。产生IL17的辅助性T细胞(Th17)被认为是银屑病发病机制中的核心作用。7 PD1抑制增强了Th17的激活和IL17.8的继发性过量产生,9因此,在抗PD1/PDL1抗体治疗过程中,有理由导致银屑病的新发和原发银屑病的恶化。然而,假设先前存在的银屑病已经建立了一种更成熟的发病机制,可能导致由于持续的银屑病皮肤炎症而停止ICI治疗的风险。为了阐明这一假设,我们总结了一例与ICI治疗相关的银屑病,特别是抗PD1/PDL1抗体治疗(表1)。我们注意到中断或中断免疫的频率更高
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来源期刊
CiteScore
0.60
自引率
10.00%
发文量
69
审稿时长
12 weeks
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