4yr
Skin Deep: A Fascinating Case Report of Immunotherapy-Triggered, Treatment-Refractory Autoimmune Lichen Planus and Keratoacanthoma - PubMed
Source : https://pubmed.ncbi.nlm.nih.gov/34703435/
This case discusses a 62-year-old woman with de novo metastatic lung adenocarcinoma (PD-L1 >50% with a KRAS G12C mutation, ALK and EGFR negative) who was on pembrolizumab for 1 year without any significant toxicity, only low-grade dermatitis and hypothyroidism. She was transitioned to pembrolizum ...
• Source: Case Reports in Oncology
• Conclusion/Relevance: “This case study is on rare auto-immune toxicity as well as a keratoacanthoma from anti-PD-(L) 1 blockade, accompanied by sustained treatment response after cessation of the offending drug.”
• This case involves a 62-year-old woman with de novo metastatic lung adenocarcinoma: PD-L1 >50% with a KRAS G12C mutation, and ALK and EGFR negative. She was administered pembrolizumab for 1 year without any toxicities, and only low-grade dermatitis and hypothyroidism. Her regimen was changed to pembrolizumab every 6 weeks at 4 mg/kg and she began to develop oral sores, which were refractory to nystatin and corticosteroid mouth rinses. She was diagnosed with autoimmune-triggered lichen planus. Her symptoms were refractory to typical treatments for lichen planus and deteriorated to where she began to manifest cutaneous lesions and had difficulty swallowing. She also developed a keratoacanthoma that needed to be excised. Pembrolizumab was ceased, and the symptoms attenuated with 5 days of systemic prednisone, metronidazole, and triamcinolone oral paste. Her NSCLC remained stable off active treatment for 6 months.
• This case reflects a very severe, treatment-refractory case of autoimmune-mediated lichen planus, which was initiated by immunotherapy for metastatic lung cancer. The immune conditions occurred with the switch to the higher dose of pembrolizumab given every 42 days.
• “This case highlights the importance of obtaining adequate tissue for complete biomarker testing, as this patient was preparing to start carboplatin and pemetrexed she agreed to an urgent EBUS-guided biopsy which revealed both PD-L1 >50% IHC and a KRAS G12C mutation, dramatically altering her treatment options,” wrote the authors. “This case also highlights the importance of a broad differential for all patients on immunotherapy, even when a cancer patient presents with a common side effect, such as mucositis. Fortunately, as in our case, the benefits of the pembrolizumab often persist beyond discontinuation of therapy.”