title: Immune-related alopecia (areata and universalis) in cancer patients receiving immune checkpoint inhibitors.
abstract: Cytotoxic T-lymphocyte-associated protein-4, programmed cell death protein and programmed cell death protein ligand 1 monoclonal antibodies (immune checkpoint inhibitors), are used to treat various malignancies. Their mechanism of action involves the inhibition of negative regulators of immune activation, resulting in immune-related adverse events (irAEs) including endocrinopathies, pneumonitis, colitis, hepatitis and dermatological events. Dermatological irAEs include maculopapular rash, pruritus, vitiligo, blistering disorders, mucocutaneous lichenoid eruptions, rosacea and the exacerbation of psoriasis. Alopecia secondary to immune checkpoint inhibitors has been reported in 1·0-2·0% of treated patients. Our objective is to characterize for the first time the clinicopathology of patients with alopecia areata (AA) secondary to immune checkpoint inhibitors, including the first report of anti-PD-L1 therapy-induced AA, and review of the literature. Four cases of patients who developed partial or complete alopecia during treatment with immune checkpoint inhibitors for underlying cancer were identified from our clinics. Methods include the review of the history and clinicopathologic features. Three patients (75%) had AA and one had universalis. Two patients had a resolution after topical, oral or intralesional therapies and one had a resolution after immunotherapy was discontinued; all regrown hair exhibited poliosis. One of the four patients had coincident onychodystrophy. This report describes a series of four patients who developed partial or complete alopecia (i.e. areata and universalis) during treatment with immune checkpoint inhibitor therapies for cancer. The recognition and management of hair-related irAEs are important for pretherapy counselling and interventions that contribute to maintaining optimal health-related quality of life in patients.
authors.affiliation: Department of Dermatology and Transitional Year Program, Henry Ford Hospital, Detroit, MI, 48202, U.S.A.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-2256-7492
authors.initials: A
authors.lastname: Zarbo
authors.affiliation: Department of Dermatology Service, Memorial Sloan Kettering Cancer Center, 60th Street Outpatient Center, Suite 407, Room 4315 16 East 60th Street, New York, NY, 10022, U.S.A.
authors.forename: V R
authors.identifier: http://orcid.org/0000-0003-3628-3412
authors.initials: VR
authors.lastname: Belum
authors.affiliation: Department of Oncodermatology, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, 31100, France.
authors.forename: V
authors.initials: V
authors.lastname: Sibaud
authors.affiliation: Department of Medical Oncology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, 75015, France.
authors.forename: S
authors.initials: S
authors.lastname: Oudard
authors.affiliation: Melanoma & Immunotherapeutics Service, Weill Cornell Medical College, New York, NY, U.S.A.
authors.forename: M A
authors.initials: MA
authors.lastname: Postow
authors.affiliation: Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, 60th Street Outpatient Center, Suite 407, Room 4315 16 East 60th Street, New York, NY, 10022, U.S.A.
authors.forename: J J
authors.initials: JJ
authors.lastname: Hsieh
authors.affiliation: Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, 60th Street Outpatient Center, Suite 407, Room 4315 16 East 60th Street, New York, NY, 10022, U.S.A.
authors.forename: R J
authors.initials: RJ
authors.lastname: Motzer
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, 60th Street Outpatient Center, Suite 407, Room 4315 16 East 60th Street, New York, NY, 10022, U.S.A.
authors.forename: K J
authors.initials: KJ
authors.lastname: Busam
authors.affiliation: Department of Dermatology Service, Memorial Sloan Kettering Cancer Center, 60th Street Outpatient Center, Suite 407, Room 4315 16 East 60th Street, New York, NY, 10022, U.S.A.
authors.forename: M E
authors.initials: ME
authors.lastname: Lacouture
mesh_terms: D000328:Adult; D000368:Aged; D000506:Alopecia Areata / Q000139:chemically induced*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D060890:B7-H1 Antigen / Q000037:antagonists & inhibitors*; D060908:CTLA-4 Antigen / Q000037:antagonists & inhibitors*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects; D007680:Kidney Neoplasms / Q000188:drug therapy; D008297:Male; D008545:Melanoma / Q000188:drug therapy; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012878:Skin Neoplasms / Q000188:drug therapy
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D060890:B7-H1 Antigen; C423236:CD274 protein, human; D060908:CTLA-4 Antigen