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Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of severe dermatological toxicities from checkpoint inhibitors

Abstract

Immune checkpoint inhibitors (ICIs) frequently result in cutaneous immune-related adverse events (IrAEs). Although the majority of these events are mild-to-moderate in severity, up to 5% are severe, which may lead to morbidity and dose interruption or discontinuation of ICI therapy. In addition, up to 25% of dermatologic IrAEs are corticosteroid-refractory or corticosteroid-dependent. These 2020 MASCC recommendations cover the diagnosis and management of cutaneous IrAEs with a focus on moderate-to-severe and corticosteroid-resistant events. Although the usage of immune-suppressive therapy has been advocated in this setting, there is a lack of randomized clinical trial data to provide a compelling level of evidence of its therapeutic benefit.

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Funding

This work was funded in part by NIH/NIAMS Grant U01AR077511 and the NIH/NCI Cancer Center Support Grant P30 CA008748. Professor BL Rapoport is supported by the Cancer Association of South Africa (CANSA) and the National Research Foundation (NRF) of South Africa. Dr. I. Glezerman is supported by the NIH/NCI (Cancer Center Support Grant P30 CA008748).

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Contributions

All of the authors contributed equally to the conceptualization of the manuscript; JC and ML shared sections on dermatologic immune-related adverse events equally, while BLR and DBJ provided clinical input and BLR, DBJ, and RA editorial oversight. All of the authors provided critical appraisal of the manuscript and approve of its submission.

Corresponding author

Correspondence to Bernardo L. Rapoport.

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Conflict of interest

AB, RA, JC, TC, PG, DG, and VRS have no conflict of interest to declare. MD reports grants from Novartis, other fees from Neoleukin Therapeutics, personal fees from Partner Therapeutics, personal fees from Tillotts Pharma, and grants from Genentech, outside the submitted work. MG reports other fees from Bristol Myers Squibb (BMS) and from AstraZeneca, outside the submitted work. IG reports stock ownership from Pfizer Inc. and personal fees from CytomX Inc., outside the submitted work. DBJ reports other fees from Array Biopharma, grants and other from BMS, other from Jansen, grants from Incyte, other from Merck, and other from Novartis, outside the submitted work. In addition, DBJ has a patent co-inventor on use of CTLA-4 agonist for IrAEs pending. ML reports other (royalties) from Legacy Healthcare Services, from Apricity Health, LLC, from Azitra, Inc., from Deciphera, from Galderma Research and Development, from Johnson and Johnson, from NCODA, from Novocure Inc., from Kyowa Kirin, Inc., from Loxo, from Merck Sharp and Dohme Corporation, from Janssen Research & Development, LLC, from Menlo Therapeutics, from Novartis Pharmaceuticals Corporation, from QED Therapeutics, from F. Hoffmann-La Roche AG, from Amgen Inc., from AstraZeneca Pharmceuticals LP, from Genentech Inc., from Seattle Genetics, from Lutris, from Paxman Coolers, from OnQuality Pharmaceuticals Ltd, and from Takeda Millenium, outside the submitted work. BLR reports personal fees and other from Merck and Co.; grants, personal fees, and other from BMS; grants, personal fees, and other from Roche South Africa; and personal fees and other fees from AstraZeneca, during the conduct of the study. MSA reports personal fees from Gilead, grants from Pfizer, and personal fees from Abbvie, outside the submitted work. All work with these entities has ended.

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Choi, J., Anderson, R., Blidner, A. et al. Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of severe dermatological toxicities from checkpoint inhibitors. Support Care Cancer 28, 6119–6128 (2020). https://doi.org/10.1007/s00520-020-05706-4

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Keywords

  • Bullous dermatoses
  • Corticosteroids
  • Cutaneous IrAEs
  • Inflammatory dermatitis
  • Pruritus
  • Skin rash
  • Vitiligo