PD-L1 expression in keratinocyte and infiltration of CD4 + T lymphocyte can predict a severe type of erythema multiforme major induced by the anti-PD-1 antibody, pembrolizumab

Skin toxicity is the most common adverse event of treatment with immune check point inhibitors. Among them, erythema multiforme is a rare occurrence with a frequency of 4%, with most of the cases developing grade 1/2 disease. We experienced high grade erythema multiforme major developing with pembro...

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Bibliographic Details
Published in:	International cancer conference journal Vol. 13; no. 3; pp. 268 - 274
Main Authors:	Kadoi, Ryohei, Yoshida, Taichi, Noto, Mai, Toyoshima, Aya, Fujii, Sino, Fukuda, Koji, Shimazu, Kazuhiro, Taguchi, Daiki, Shinozaki, Hanae, Kodama, Naoki, Kono, Michihiro, Nanjyo, Hiroshi, Shibata, Hiroyuki
Format:	Journal Article
Language:	English
Published:	Singapore Springer Nature Singapore 01-07-2024 Springer Nature B.V
Subjects:	Abdomen Antibodies Anus Biopsy Cancer therapies Case Report - Complication CD4 antigen Dermatitis Erythema Erythema multiforme Keratinocytes Lymphatic system Lymphocytes T Medicine Medicine & Public Health Metastases Metastasis Methylprednisolone Oncology PD-1 protein PD-L1 protein Pembrolizumab Prednisolone Skin diseases Skin lesions Steroids Surgical Oncology Tomography Toxicity Viral infections PD-L1 expression Erythema multiforme major Anti-PD-1 antibody CD8 T cell Severe cutaneous adverse reaction CD8+ T cell
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Summary:	Skin toxicity is the most common adverse event of treatment with immune check point inhibitors. Among them, erythema multiforme is a rare occurrence with a frequency of 4%, with most of the cases developing grade 1/2 disease. We experienced high grade erythema multiforme major developing with pembrolizumab treatment for anal canal cancer with extensive skin metastases. Steroid ointment was ineffective, and the skin lesions with blisters expanded to > 45% of the body surface area. The patient was at risk for symptom aggravation, and a pulse therapy with methylprednisolone and increasing the dose of oral prednisolone (1 mg/kg) were started. The skin lesions improved in 1.8 months. Unless urgent and appropriate treatments such as high dose steroid administration were conducted, the skin toxicities could not be controlled. The presence of CD4 + T cells and PD-L1 + keratinocytes in the skin biopsy might be a predictive marker of erythema multiforme major resistant to standard steroid treatment.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2192-3183 2192-3183
DOI:	10.1007/s13691-024-00676-4