title: Bullous pemphigoid, an autoantibody-mediated disease, is a novel immune-related adverse event in patients treated with anti-programmed cell death 1 antibodies.
abstract: Anti-programmed cell death 1 (anti-PD1) antibodies such as pembrolizumab have shown improved progression-free and overall survival in patients with advanced melanoma. Of 124 patients reviewed in Westmead Hospital from May 2012 to November 2015, treated with pembrolizumab for advanced melanoma, we encountered three cases of bullous pemphigoid (BP). We have previously reported a case of BP. In two recent cases, BP was diagnosed early and treated promptly with potent topical or oral steroid. Patients on anti-PD1 antibodies are at a higher risk of developing cutaneous immune-related adverse events such as lichenoid reactions, eczema and vitiligo. No cases of BP were encountered in the previously published cohort of 260 melanoma patients treated with BRAF inhibitors; as such, it appears that BP is associated with anti-PD1 treatment rather than metastatic melanoma. BP appears to be another immune-related adverse event, and clinicians should have a low threshold for performing cutaneous biopsies and immunofluorescence studies in patients on anti-PD1 therapies.
authors.affiliation: Departments of aDermatology bTissue Pathology and Diagnostic Oncology cCrown Princess Mary Cancer Centre, Westmead Hospital dSydney Medical School, The University of Sydney eMelanoma Institute Australia, Sydney, New South Wales, Australia.
authors.forename: Shelley J E
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Giuliana
authors.initials: G
authors.lastname: Carlos
authors.forename: Shaun
authors.initials: S
authors.lastname: Chou
authors.forename: Deepal
authors.initials: D
authors.lastname: Wakade
authors.forename: Matteo S
authors.initials: MS
authors.lastname: Carlino
authors.forename: Pablo
authors.initials: P
authors.lastname: Fernandez-Penas
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D010391:Pemphigoid, Bullous / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D061026:Programmed Cell Death 1 Receptor / Q000037:antagonists & inhibitors* / Q000276:immunology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C105992:PDCD1 protein, human; D061026:Programmed Cell Death 1 Receptor; C582435:pembrolizumab