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- Presentation
Advanced Therapeutics for Dermatologic Immune Related Adverse Events (D-irAE)
Description
In this presentation, Steven Chen discusses advanced therapeutics for dermatologic immune-related adverse events (D-irAE) associated with cancer immunotherapy, particularly immune checkpoint inhibitors (ICI). He highlights the significance of understanding the morphology of skin rashes to establish proper treatment algorithms, emphasizing that adverse events in the skin can vary based on the specific immunotherapy used and the type of cancer being treated. Chen presents data indicating that the incidence of dermatologic adverse effects is likely underreported in clinical trials, particularly when dermatologists are not involved. He outlines treatment strategies based on the morphology of the rash, referencing the new Delphi consensus criteria for diagnosing various forms of skin reactions linked to ICIs. Treatment approaches include topical steroids for mild cases and systemic therapies, such as prednisone and tocilizumab, for more severe reactions. He notes the importance of considering second triggers that can exacerbate reactions, especially in the context of ICI psoriasis and eczema, where treatments like Dupilumab have shown promise. Chen stresses the need for collaboration with oncologists when managing D-irAEs and the necessity of achieving a tolerable condition rather than complete clearance, allowing patients to continue their cancer treatments. The discussion underlines the challenges in treating these conditions and the evolving understanding of how to approach them.
View moreConclusions
- The treatment of dermatologic immune-related adverse events (D-irAEs) should be based on the morphology of the rash.
- There is a significant prevalence of skin toxicities in patients receiving immune checkpoint inhibitors, often reported higher than clinical trials suggest.
- Current treatment guidelines for dermatologic toxicity of immune checkpoint inhibitors are limited and need to be more detailed.
- A new Delphi consensus criteria offers a standardized approach for classifying and diagnosing dermatologic adverse events based on morphology.
- Combination therapies with immune checkpoint inhibitors can lead to severe dermatologic toxicities, and the management of these conditions is critical for continued cancer therapy.
- Topical steroids are recommended for mild to moderate D-irAEs, while systemic treatments may be required for severe cases.
- Early introduction of systemic steroids may correlate with poorer cancer prognosis, suggesting the need for careful management.
- Patients with pre-existing conditions like psoriasis can typically continue cancer treatments, as exacerbations can be managed with topical therapies.
- Tocilizumab and other biologics are emerging as effective treatments for severe D-irAEs but must be used cautiously in the context of concurrent therapies.
- The goal of treatment should focus on achieving tolerable levels of skin toxicity, allowing patients to continue their cancer therapy rather than complete clearance of rashes.
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