Cutaneous adverse events (AEs) from anti-CTLA4 and anti-PD1 combination therapy for metastatic melanoma are mostly mild and can be managed using topical steroids and/or oral histamines, according to a study published as a part of the 2020 American Academy of Dermatology Virtual Meeting Experience.
A chart review of the University of Texas Health Science Center database was conducted for 155 patients consecutively treated for unresectable stage III/IV melanoma from 2012 to 2017. Patients included in the review had received regimens consisting of at least 1 dose of ipilimumab combined with either nivolumab (n = 146) or pembrolizumab (n = 11).
Of the 157 regimens received, 82 (52.2%) resulted in 93 cutaneous AEs. The most common cutaneous AEs were eczema (26%), morbilliform eruption (23%), vitiligo (12%), and pruritis without rash (9%).
A total of 97 (61.7%) regimens resulted in treatment discontinuation prior to reaching anti-PD1 maintenance therapy. Immune-related AEs included gastrointestinal (39%), hepatic (37.3%), endocrine (11.9%), and pulmonary (11.9%) toxicities, and accounted for 59 (60.8%) treatment discontinuations. Cutaneous AEs accounted for 4 (5%) treatment discontinuations.
Overall, 13 (8.3%) regimens were discontinued or delayed due to cutaneous AEs. Of these, 7 required systemic steroids and 4 were managed using topical steroids combined with oral histamines.
Researchers noted that the majority of cutaneous AEs were managed using topical steroids and/or oral histamines. Additionally, the majority of cutaneous AEs were resolved after entering anti-PD1 maintenance therapy. The only cutaneous AE that did not resolve was vitiligo.
In their concluding remarks, researchers noted that, “Physicians and patients will benefit from knowing which adverse effects pose the most risk of negatively impacting course of combination anti-CTLA4 and anti-PD1 therapy for metastatic melanoma. Early management is crucial to limit treatment interruptions and negative impacts on quality of life.”—Janelle Bradley
