1. Diffuse lichen planus-like keratoses and clinical pseudo-progression associated with avelumab treatment for Merkel cell carcinoma, a case report.
- Author
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Cardis MA, Jiang H, Strauss J, Gulley JL, and Brownell I
- Subjects
- Aged, Antibodies, Monoclonal administration & dosage, Antibodies, Monoclonal pharmacology, Antibodies, Monoclonal, Humanized, Antineoplastic Agents administration & dosage, Antineoplastic Agents pharmacology, B7-H1 Antigen antagonists & inhibitors, Cryotherapy, Disease Progression, Glucocorticoids therapeutic use, Humans, Keratosis drug therapy, Keratosis immunology, Male, Positron Emission Tomography Computed Tomography, Programmed Cell Death 1 Receptor antagonists & inhibitors, Treatment Outcome, Triamcinolone therapeutic use, Antibodies, Monoclonal adverse effects, Antibodies, Monoclonal therapeutic use, Antineoplastic Agents adverse effects, Antineoplastic Agents therapeutic use, Carcinoma, Merkel Cell drug therapy, Keratosis etiology, Lichen Planus pathology, Skin Neoplasms drug therapy
- Abstract
Background: Avelumab is an anti-programmed cell death ligand 1 (PD-L1) antibody approved for treatment of Merkel cell carcinoma (MCC) and locally advanced or metastatic urothelial carcinoma. It shares a similar side effect profile to other immune checkpoint inhibitors, including immune-related adverse reactions in the skin. These adverse skin reactions can present as a morbilliform exanthem, lichenoid dermatitis, vitiligo, autoimmune bullous disorder, among others., Case Presentation: We describe a patient with advanced MCC successfully treated with avelumab who developed acute onset diffuse lichen planus-like keratoses (LPLK) at sites of existing seborrheic keratoses (SK) and lentigines. Histopathology of an affected SK revealed papillomatous epidermal hyperplasia with lichenoid interface changes, numerous dyskeratotic keratinocytes and intermittent hypergranulosis. The findings resembled lichen planus (LP) arising in an SK. Onset of the skin symptoms corresponded with an inflammatory cancer response (clinical pseudo-progression), and the eruption improved as overall tumor burden decreased. The patient's pruritus was treated with topical steroids and cyrotherapy for individual symptomatic lesions., Conclusion: Diffuse LPLK is a distinct immune-related reaction pattern associated with PD-L1/PD-1 checkpoint blockade. This is an important side effect to be aware of as LPLK frequently mimic keratinocytic neoplasms. Further observation is needed to assess the prevalence and significance of this immune therapy-associated adverse reaction.
- Published
- 2019
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