Ipilimumab in patients with cancer and the management of dermatologic adverse events.
Ipilimumab is a fully human monoclonal antibody that blocks cytotoxic T-lymphocyte antigen-4 to augment antitumor T-cell responses. Phase III studies have demonstrated survival benefit in both previously treated and treatment-naïve patients with metastatic melanoma. In clinical trials, adverse events (AEs) related to treatment with ipilimumab were mostly grade 1/2 (as per Common Terminology Criteria for AEs, Version 4.02), and mostly reversible with appropriate management. Distinct immune-related AEs that may reflect the mechanism of action of ipilimumab have been identified, and occur commonly in the skin, typically presenting as a maculopapular rash, which can be accompanied by pruritus, pruritus with no skin lesions, alopecia, and vitiligo. Histologic analyses have revealed epidermal spongiosis, and perivascular CD4(+) T-cell infiltrates with some eosinophils in areas of rash. Timely implementation of toxicity-specific treatment guidelines that emphasize vigilance and early intervention allows mitigation of dermatologic AEs. Adherence to guidelines is necessary to maintain quality of life, ensure consistent dosing, and obtain the best possible clinical outcome.
Memorial Sloan Kettering Cancer Center, New York, New York; Weill-Cornell Medical College, New York, New York. Electronic address: lacoutum@mskcc.org.
Mario E
ME
Lacouture
Memorial Sloan Kettering Cancer Center, New York, New York; Weill-Cornell Medical College, New York, New York; Ludwig Institute for Cancer Research, New York, New York.
Jedd D
JD
Wolchok
Departments of Dermatology, Neurobiology and Anatomy, and Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina.
Gil
G
Yosipovitch
Department of Dermatology, University of Kiel, Kiel, Germany.
Katharina C
KC
Kähler
Memorial Sloan Kettering Cancer Center, New York, New York.
Klaus J
KJ
Busam
Department of Dermatology, University of Kiel, Kiel, Germany.
Axel
A
Hauschild
D000505:Alopecia / Q000139:chemically induced; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D005076:Exanthema / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D017496:Hypopigmentation / Q000139:chemically induced; D000074324:Ipilimumab; D008545:Melanoma / Q000188:drug therapy*; D011537:Pruritus / Q000139:chemically induced; D012878:Skin Neoplasms / Q000188:drug therapy*; D013601:T-Lymphocytes / Q000187:drug effects
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000074324:Ipilimumab
adverse event management; dermatologic; immune-related; ipilimumab; melanoma; pruritus; rash; vitiligo