PMID- 30244487 OWN - NLM STAT- MEDLINE DCOM- 20201002 LR - 20201002 IS - 1365-2133 (Electronic) IS - 0007-0963 (Linking) VI - 181 IP - 3 DP - 2019 Sep TI - Subacute cutaneous lupus erythematosus and dermatomyositis associated with anti-programmed cell death 1 therapy. PG - 580-583 LID - 10.1111/bjd.17245 [doi] AB - Programmed cell death 1 (PD-1) blockade has rapidly emerged as an effective therapy for a wide variety of metastatic malignancies. It has been associated with multiple immune-related adverse effects, including cutaneous eruptions. We describe two patients with clinical and histological findings that were consistent with subacute cutaneous lupus erythematosus (SCLE) after receiving PD-1 inhibitor therapy for metastatic lung cancer. We successfully treated our first patient with systemic and topical steroids, photoprotection and hydroxychloroquine. However, he subsequently developed dermatomyositis after continuing PD-1 inhibitor therapy. Our second patient presented with a protracted course of a cutaneous eruption in spite of discontinuation of anti-PD-1 therapy and treatment with systemic corticosteroids and infliximab. This patient's SCLE resolved after the addition of topical steroids and photoprotection and discontinuation of anti-tumour necrosis factor therapy. She and her oncology team decided to pursue non-PD-1 inhibitor treatment for lung cancer owing to a lack of tumour response. We add SCLE and dermatomyositis to the growing list of autoimmune complications of PD-1 blockade. Our cases raise a number of questions, particularly in relation to the viability of continuing anti-PD-1 therapy after developing SCLE and the role of immunosuppressive therapy in patients with PD-1 inhibitor-associated connective tissue disease. What's already known about this topic? Programmed cell death 1 (PD-1) blockade, which is rapidly emerging as a therapy for a wide variety of metastatic malignancies, has been associated with multiple immune-related adverse effects. These include systemic autoimmune diseases such as colitis and thyroiditis in addition to numerous cutaneous adverse events. Cutaneous side-effects of PD-1 inhibitors most commonly reported in clinical trials include lichenoid reactions, eczematous dermatitis and vitiligo. What does this study add? We report two cases of PD-1 inhibitor-associated subacute cutaneous lupus erythematosus (SCLE), with one patient progressing to dermatomyositis with continued PD-1 inhibitor treatment. In addition to being a novel cutaneous adverse event, we also demonstrate the possibility of development of multiple autoimmune diseases in one patient, which is different from classic drug-related SCLE. We discuss the treatment challenges for patients with autoimmune skin disease receiving PD-1 inhibitor therapy. CI - (c) 2018 British Association of Dermatologists. FAU - Marano, A L AU - Marano AL AD - Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A. FAU - Clarke, J M AU - Clarke JM AD - Department of Medicine, Duke University Medical Center, Durham, NC, U.S.A. AD - Duke Cancer Institute, Duke University Medical Center, Durham, NC, U.S.A. FAU - Morse, M A AU - Morse MA AD - Department of Medicine, Duke University Medical Center, Durham, NC, U.S.A. AD - Duke Cancer Institute, Duke University Medical Center, Durham, NC, U.S.A. FAU - Shah, A AU - Shah A AD - Department of Medicine, Duke University Medical Center, Durham, NC, U.S.A. AD - Division of Rheumatology, Duke University Medical Center, Durham, NC, U.S.A. FAU - Barrow, W AU - Barrow W AD - Ameripath Inc., Palm Beach Gardens, FL, U.S.A. FAU - Selim, M A AU - Selim MA AD - Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A. AD - Department of Pathology, Duke University Medical Center, Durham, NC, U.S.A. FAU - Hall, R P 3rd AU - Hall RP 3rd AUID- ORCID: 0000-0001-7621-4935 AD - Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A. AD - Department of Immunology, Duke University Medical Center, Durham, NC, U.S.A. FAU - Cardones, A R AU - Cardones AR AUID- ORCID: 0000-0001-7489-2046 AD - Department of Dermatology, Duke University Medical Center, Durham, NC, U.S.A. AD - Duke Cancer Institute, Duke University Medical Center, Durham, NC, U.S.A. LA - eng PT - Case Reports PT - Journal Article DEP - 20181210 PL - England TA - Br J Dermatol JT - The British journal of dermatology JID - 0004041 RN - 0 (Antibodies, Monoclonal, Humanized) RN - 0 (Antineoplastic Agents, Immunological) RN - 0 (PDCD1 protein, human) RN - 0 (Programmed Cell Death 1 Receptor) RN - 31YO63LBSN (Nivolumab) RN - DPT0O3T46P (pembrolizumab) SB - IM CIN - Br J Dermatol. 2019 Sep;181(3):445-446. PMID: 31240710 MH - Antibodies, Monoclonal, Humanized/*adverse effects MH - Antineoplastic Agents, Immunological/*adverse effects MH - Biopsy MH - Carcinoma, Non-Small-Cell Lung/drug therapy/immunology MH - Dermatomyositis/chemically induced/diagnosis/*immunology/pathology MH - Female MH - Humans MH - Lung Neoplasms/drug therapy/immunology MH - Lupus Erythematosus, Cutaneous/chemically induced/diagnosis/*immunology/pathology MH - Male MH - Middle Aged MH - Nivolumab/adverse effects MH - Programmed Cell Death 1 Receptor/*antagonists & inhibitors/immunology MH - Skin/drug effects/immunology/pathology MH - Small Cell Lung Carcinoma/drug therapy/immunology EDAT- 2018/09/24 06:00 MHDA- 2020/10/03 06:00 CRDT- 2018/09/24 06:00 PHST- 2018/09/18 00:00 [accepted] PHST- 2018/09/24 06:00 [pubmed] PHST- 2020/10/03 06:00 [medline] PHST- 2018/09/24 06:00 [entrez] AID - 10.1111/bjd.17245 [doi] PST - ppublish SO - Br J Dermatol. 2019 Sep;181(3):580-583. doi: 10.1111/bjd.17245. Epub 2018 Dec 10.