Enfortumab vedotin-induced cutaneous eruption: Ring mitotic figures as a distinctive histopathologic feature

IF 1.6 4区 医学 Q3 DERMATOLOGY
Catherine Sport, Rebecca C. Clawson, Lauren E. Tisdale, John W. Melson, Mark C. Mochel
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Abstract

Enfortumab vedotin (EV), a nectin-4-binding agent that affects microtubules, has become standard therapy for advanced urothelial carcinoma. The agent, now given in combination with pembrolizumab, frequently induces cutaneous reactions. Here, we report a severe EV-induced cutaneous eruption. A 58-year-old woman with metastatic urothelial carcinoma developed a rash after receiving simultaneous first doses of EV and pembrolizumab. The eruption began on the flank and spread to involve her trunk and extremities with prominent involvement of folds, including the axillae and medial thighs. Skin biopsy revealed extensive vacuolar alteration of the basal epidermis and numerous epidermal keratinocytic mitotic figures, often suprabasilar, including ring and “starburst” forms. The findings supported a diagnosis of EV-induced eruption. With EV cessation and systemic corticosteroids, the rash resolved over a few weeks. Pembrolizumab was restarted as monotherapy, and the patient's cancer showed a significant radiographic treatment response at 3 months. An emerging literature of small series and case reports, largely from oncologic literature, presents the histopathology of EV-induced cutaneous eruption as a vacuolar interface dermatitis with the inconsistently reported feature of arrested mitotic figures. This case study demonstrates distinctive clinical and histopathologic features of EV-induced eruption, which may inform dermatologic and oncologic management.

Abstract Image

恩福单抗维多汀诱发的皮肤糜烂:环状有丝分裂图是一种独特的组织病理学特征
Enfortumab vedotin(EV)是一种能影响微管的 nectin-4 结合剂,已成为晚期尿路上皮癌的标准疗法。该药物目前与 pembrolizumab 联用,经常诱发皮肤反应。在此,我们报告了一起严重的EV诱导的皮肤糜烂。一名患有转移性尿路上皮癌的 58 岁女性在同时接受首剂 EV 和 pembrolizumab 后出现皮疹。皮疹从侧腹开始,蔓延至躯干和四肢,腋窝和大腿内侧等褶皱部位明显受累。皮肤活检显示,基底表皮出现广泛的空泡样改变,表皮角质细胞有丝分裂,通常在基底上,包括环状和 "星状"。这些结果支持 EV 诱发的糜烂诊断。在停用EV和全身使用皮质类固醇激素后,皮疹在数周内消退。重新开始使用 Pembrolizumab 作为单药治疗,患者的癌症在 3 个月后出现了明显的放射治疗反应。新出现的小型系列文献和病例报告(主要来自肿瘤学文献)显示,EV 诱导的皮肤糜烂在组织病理学上表现为空泡界面皮炎,并伴有报道不一致的有丝分裂停止的特征。本病例研究展示了EV诱发的皮肤糜烂的独特临床和组织病理学特征,可为皮肤病学和肿瘤学治疗提供参考。
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来源期刊
CiteScore
3.20
自引率
5.90%
发文量
174
审稿时长
3-8 weeks
期刊介绍: Journal of Cutaneous Pathology publishes manuscripts broadly relevant to diseases of the skin and mucosae, with the aims of advancing scientific knowledge regarding dermatopathology and enhancing the communication between clinical practitioners and research scientists. Original scientific manuscripts on diagnostic and experimental cutaneous pathology are especially desirable. Timely, pertinent review articles also will be given high priority. Manuscripts based on light, fluorescence, and electron microscopy, histochemistry, immunology, molecular biology, and genetics, as well as allied sciences, are all welcome, provided their principal focus is on cutaneous pathology. Publication time will be kept as short as possible, ensuring that articles will be quickly available to all interested in this speciality.
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