title: Cutaneous adverse events (AEs) of anti-programmed cell death (PD)-1 therapy in patients with metastatic melanoma: A single-institution cohort.
abstract: BACKGROUND
  Anti-programmed cell death (PD)-1 therapy is emerging as the backbone of new standard of care immunotherapy for metastatic melanoma. Immune-related cutaneous events are observed in these patients.
  
  
  OBJECTIVE
  We sought to describe cutaneous adverse events observed in patients with metastatic melanoma on anti-PD-1 therapy.
  
  
  METHODS
  We reviewed the clinical and histologic information of all patients treated with single-agent anti-PD-1 therapy for metastatic melanoma at Westmead Hospital, Sydney, Australia, from May 2012 to February 2015.
  
  
  RESULTS
  Of the 82 patients included in the study, 34 had dermatology assessments. Forty (49%) developed a form of anti-PD-1-associated cutaneous adverse events. In all, 17% developed lichenoid reactions and eczema, and 15% developed vitiligo. An estimated 25% of patients were expected to develop their first lichenoid reactions within 8.3 months, and eczema and vitiligo within 10.3 months of therapy. These adverse events tend to appear together in patients on anti-PD-1 therapy.
  
  
  CONCLUSIONS
  The study was from a single center and clinical information was reviewed retrospectively in patients not referred to dermatology.
  
  
  CONCLUSIONS
  Anti-PD-1 therapy is associated with the development of immune-related cutaneous events. Lichenoid reactions, eczema, and vitiligo are the 3 most prevalent lesions observed in our population. There is a tendency for lichenoid reactions and eczema to occur with vitiligo.
authors.affiliation: Department of Dermatology, Westmead Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia. Electronic address: shelley.hwang@hotmail.com.
authors.forename: Shelley Ji Eun
authors.initials: SJ
authors.lastname: Hwang
authors.affiliation: Department of Dermatology, Westmead Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Carlos
authors.affiliation: Department of Dermatology, Westmead Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Deepal
authors.initials: D
authors.lastname: Wakade
authors.affiliation: Research and Education Network, Westmead Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Byth
authors.affiliation: Crown Princess Mary Cancer Center, Westmead Hospital, Sydney, Australia.
authors.forename: Benjamin Y
authors.initials: BY
authors.lastname: Kong
authors.affiliation: Tissue Pathology and Diagnostic Oncology, Westmead Hospital, Sydney, Australia.
authors.forename: Shaun
authors.initials: S
authors.lastname: Chou
authors.affiliation: Crown Princess Mary Cancer Center, Westmead Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Melanoma Institute Australia, Sydney, Australia.
authors.forename: Matteo S
authors.initials: MS
authors.lastname: Carlino
authors.affiliation: Crown Princess Mary Cancer Center, Westmead Hospital, Sydney, Australia; Melanoma Institute Australia, Sydney, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Kefford
authors.affiliation: Department of Dermatology, Westmead Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Pablo
authors.initials: P
authors.lastname: Fernandez-Penas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects*; D017209:Apoptosis / Q000187:drug effects; D003875:Drug Eruptions / Q000453:epidemiology / Q000209:etiology*; D004485:Eczema / Q000139:chemically induced*; D005260:Female; D006801:Humans; D017512:Lichenoid Eruptions / Q000139:chemically induced*; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary*; D008875:Middle Aged; D000077594:Nivolumab; D011446:Prospective Studies; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D014820:Vitiligo / Q000139:chemically induced*; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000077594:Nivolumab; C582435:pembrolizumab
keywords: anti-programmed cell death-1; eczema; immune reaction; immunotherapy; lichenoid reaction; metastatic melanoma; vitiligo