Abstract
Background: Pruritus is a frequent adverse event during the use of immune checkpoint inhibitors (ICIs), with a frequency estimated to be between 11 and 47%. The underlying causes remain poorly understood.Objectives: The main goal was to search for putative causes of pruritus occurring in patients treated with ICIs for melanomas and cutaneous carcinomas. Other objectives were to assess the association between the occurrence of pruritus and survival and between the occurrence of pruritus and other adverse events.Methods: A monocentric retrospective descriptive study was performed using data for patients treated with ICIs (nivolumab, pembrolizumab, ipilimumab, and cemiplimab) between August 2010 and November 2019.Results: A total of 181 patients were included (mean age: 69 years). Pruritus was reported by 25 patients (13.8%). We were able to determine three subgroups of pruritus causes under ICI use: pruritus directly related to immunotherapy, pruritus indirectly related through other pruritus-inducing side effects and pruritus unrelated to ICIs. In 6/25 patients, no more specific cause of pruritus was found at the onset of pruritus or in their backgrounds, other than ICI use.Limitations: The study has some limitations due to unicentric and retrospective design.Conclusion: Pruritus was found in 25/181 patients in this series; only in 6/25 patients no potential cause other than ICI could be found, and pruritus was not associated with differences in survival.
Highlights
Immune checkpoint inhibitors (ICIs) are commonly used in the therapeutic arsenal of metastatic melanoma, Merkel cell carcinoma and cutaneous squamous cell carcinoma due to their inhibitory effects on cytotoxic T-lymphocyte-associated protein 4 or anti-programmed death1
Ipilimumab, pembrolizumab and nivolumab (PD1 inhibitors) are the available ICIs used in melanoma for ipilimumab since 2014, for pembrolizumab and nivolumab
Some authors report a correlation between the occurrence of some cutaneous adverse events while taking ICIs and survival [19,20,21,22,23]
Summary
Immune checkpoint inhibitors (ICIs) are commonly used in the therapeutic arsenal of metastatic melanoma, Merkel cell carcinoma and cutaneous squamous cell carcinoma due to their inhibitory effects on cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA4) or anti-programmed death (anti-PD1). Data on the presence and characteristics of pruritus in patients treated with ICIs have been provided, but without analyzing the causes of the pruritus [18] It is not known whether the occurrence of pruritus is related to direct or indirect effects of ICIs. some authors report a correlation between the occurrence of some cutaneous adverse events (but not pruritus) while taking ICIs and survival [19,20,21,22,23]. The principal aim of our study was to analyse the putative causes of pruritus occurring without any skin lesions in patients treated with ICIs for melanomas and cutaneous carcinomas.
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