免疫检查点抑制剂治疗后原发性银屑病加重

IF 1.1 Q4 ALLERGY

Journal of Cutaneous Immunology and Allergy Pub Date : 2022-06-08 DOI:10.1002/cia2.12244

Yoko Minokawa MD, Yu Sawada MD, PhD

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引用次数: 1

摘要

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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Exacerbation of pre-existence psoriasis following immune checkpoint inhibitor treatment

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Exacerbation of pre-existence psoriasis following immune checkpoint inhibitor treatment

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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来源期刊

Journal of Cutaneous Immunology and Allergy Medicine-Dermatology

CiteScore

0.60

自引率

10.00%

发文量

审稿时长

12 weeks