Drug reactions with eosinophilia and systemic symptoms induced by immune checkpoint inhibitors: an international cohort of 13 cases.
Humans
Adolescent
Immune Checkpoint Inhibitors
/ therapeutic use
Nivolumab
/ adverse effects
Retrospective Studies
Melanoma
/ drug therapy
Skin Neoplasms
/ drug therapy
Eosinophilia
/ drug therapy
Drug Hypersensitivity Syndrome
/ drug therapy
Steroids
/ adverse effects
Biological Products
/ therapeutic use
Journal
Melanoma research
ISSN: 1473-5636
Titre abrégé: Melanoma Res
Pays: England
ID NLM: 9109623
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
pubmed:
8
2
2023
medline:
25
2
2023
entrez:
7
2
2023
Statut:
ppublish
Résumé
Among dermatologic adverse events induced by immune checkpoint inhibitors (ICI), drug reactions with eosinophilia and systemic symptoms (DRESS) have been very rarely reported. The objective of this study is to better define the clinical and histologic features, treatment and prognosis of ICI-related DRESS. This retrospective case series was conducted between 01 January 2015 and 31 December 2021 by the dermatology departments of five international networks involved in drug reactions. Inclusion criteria were age ≥18 years old, DRESS with Regiscar score ≥4 (probable or certain) and ICI as a suspect drug. Clinical, biologic and follow-up data were extracted from the medical charts. Thirteen patients were included. The median time to onset was 22 days (3-11). No patients had a high-risk drug introduced in the past 3 months. A majority of patients presented fever (92%), diffuse exanthema (77%) and facial edema (69%). Biologic features included hypereosinophilia in eight patients (61.5%), hyperlymphocytosis in 3 (23%), elevated liver function tests in 11 (85%, grade 1 or 2 in most cases) and renal involvement in 5 (38%). Two patients (15%) had lung involvement. PCR evidence of viral replication was detected in five patients (38.5%). Treatment involved discontinuation of the suspect ICI and systemic steroids with variable dose and duration regimens. Among the four patients in which ipilimumab + nivolumab combination therapy was initially suspected, one was rechallenged with nivolumab monotherapy with good tolerance. Five patients were switched to another anti-PD-1 plus low-dose systemic steroids, with good tolerance in four cases. No patient died because of DRESS. DRESS induced by ICI are rare and of moderate severity. A consensus for management is still pending.
Identifiants
pubmed: 36749114
doi: 10.1097/CMR.0000000000000877
pii: 00008390-202304000-00008
doi:
Substances chimiques
Immune Checkpoint Inhibitors
0
Nivolumab
31YO63LBSN
Steroids
0
Biological Products
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
155-158Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Références
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