Cutaneous Side Effects of PD-1 Inhibitors: A Single-Center Retrospective Study - Immune-related dermatologic outcomes in melanoma patients

Q: What is the main objective of this study?

To analyze dermatologic adverse events in melanoma patients treated with PD-1 inhibitors for metastatic or adjuvant indications.

Q: How were patients selected for the retrospective cohort?

Patients with stage III or IV melanoma receiving PD-1 inhibitor monotherapy (pembrolizumab or nivolumab) were included from August 2015 and followed until May 2022, with exclusions for lost follow-up and clinical trial combination therapy with ipilimumab.

Q: What cutaneous adverse events were most common?

Vitiligo, maculopapular rash, and pruritus were the most prevalent, followed by xerostomia and lichenoid dermatitis.

Sep 24, 2026

Uploaded by Rizky

Immune checkpoint inhibitors ushered in a new era of cancer immunotherapy, yet their use is limited by immune-related adverse events, especially cutaneous toxicities. This retrospective single-center study evaluated cutaneous side effects in melanoma patients treated with PD-1 inhibitors (pembrolizumab or nivolumab) between August 2015 and May 2022. Among 174 patients, 29% experienced cutaneous adverse events. Common toxicities included vitiligo, maculopapular rash, pruritus, xerostomia, and lichenoid dermatitis, managed mainly with topical corticosteroids and emollients. Dermatologic events correlated with improved progression-free and overall survival, without influence from established melanoma prognostic factors.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

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Abstract

Introduction

Materials and Methods

International Journal of Dermatology ORIGINAL ARTICLE OPEN ACCESS Skin Cancer Cutaneous Side Effects of PD-1 Inhibitors: A Single-Center Retrospective Study Melánia Pozsgai1 | Udoh Frieda-Rex Sebastian2 | Péter Oláh1 | Viktória Németh1 | Rolland Gyulai1,3 | Zsuzsanna Lengyel1 1Department of Dermatology, Venerology and Oncodermatology Clinical Center, University of Pécs, Pécs, Hungary | 2Malta Foundation Program, Mater Dei Hospital, Msida, Malta | 3Department of Dermatology and Allergology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary Correspondence: Melánia Pozsgai ([melani.pozsgai@gmail.com](melani.pozsgai@gmail.com)) Received: 22 August 2024 | Revised: 10 January 2025 | Accepted: 27 January 2025 Funding: The research was financed by the Thematic Excellence Program 2021 Health Sub-programme of the Ministry for Innovation and Technology in Hungary, within the framework of the EGA-10 project of the University of Pécs. Keywords: immune checkpoint inhibitors | immune-related cutaneous side effect | melanoma | PD-1 inhibitor | skin toxicity ABSTRACT Background: The introduction of immune checkpoint inhibitors (ICIs) opened a new era in cancer immunotherapy. In particular, PD-1 inhibitors have shown remarkable efficacy in various cancers, most notably melanoma. However, the widespread use of immune checkpoint inhibitors comes with the challenge of immune-related adverse events (irAEs), with cutaneous toxicities being the most prevalent. Methods: A retrospective, single-center study was carried out to investigate the cutaneous side effects in patients diagnosed with melanoma and treated with PD-1 inhibitors (pembrolizumab or nivolumab) at the Department of Dermatology, Venereology, and Oncodermatology, University of Pécs, Hungary. The study included patients with stage III or IV melanoma who received PD-1 inhibitor monotherapy, either for metastatic or adjuvant purposes, from August 2015 to May 2022. Results: A cohort of 174 patients was examined, with 29% experiencing cutaneous adverse events (cAEs). The most prevalent cutaneous toxicities were vitiligo (n = 18; 27%), maculopapular rash (n = 14; 21%), pruritus (n = 14; 21%), xerostomia (n = 8; 12%), and lichenoid dermatitis (n = 4; 6%) . Treatment primarily involved topical corticosteroids and emollients, with a few cases requiring systemic therapy. Notably, the occurrence of dermatologic adverse events was associated with improved progression-free survival (PFS) (p = 0.007) and overall survival (OS) (p = 0.026) compared to those without any skin toxicity (p < 0.0001), emphasizing their potential prognostic significance. Our data were not influenced by any well-known prognostic factors of melanoma. Conclusion: Our study contributes to the growing body of evidence supporting the prognostic value of cutaneous adverse events in patients treated with PD-1 inhibitors. Optimizing treatment strategies while maintaining oncologic therapy is essential, highlighting the role of dermatologists in multidisciplinary cancer care. 1 | Introduction The discovery of immune checkpoint molecules has been vital to the advancement of cancer immunotherapy. Over the past decade, immune checkpoint inhibition has led to significant therapeutic advances in hematologic and solid tumor oncology, with melanoma being the first cancer where this therapy was initially used [1] . However, these advancements are accompanied by the challenge of immune-related adverse events. Cutaneous adverse events have emerged as one of the most prevalent reactions [1, 2] . Immune checkpoint-inhibitors (ICIs) have the potential to exacerbate preexisting autoimmune or inflammatory skin disorders, trigger their recurrence, or even lead to the onset of new immune-mediated dermatoses [3, 4] . Cutaneous This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium,

FAQs

What is the main objective of this study?

To analyze dermatologic adverse events in melanoma patients treated with PD-1 inhibitors for metastatic or adjuvant indications.

How were patients selected for the retrospective cohort?

Patients with stage III or IV melanoma receiving PD-1 inhibitor monotherapy (pembrolizumab or nivolumab) were included from August 2015 and followed until May 2022, with exclusions for lost follow-up and clinical trial combination therapy with ipilimumab.

What cutaneous adverse events were most common?

Vitiligo, maculopapular rash, and pruritus were the most prevalent, followed by xerostomia and lichenoid dermatitis.

Sep 24, 2026

Uploaded by Rizky