Systemic treatment of immune checkpoint inhibitor-induced psoriasis: Inference-based guidance
Por:
Papp, KA, Puig, L, Beecker, J, Chandran, V, Claveau, J, Cortes, J, Dutz, J, Hornick, NI, Juergens, RA, Melosky, B, Patel, AB, Sauder, MB, Sehdev, S, Sibaud, V, Snow, SL
Publicada:
1 nov 2025
Ahead of Print:
1 jul 2025
Resumen:
BackgroundImmune checkpoint inhibitors (ICIs) are increasingly used to treat various cancers. Their use may result in immune-related adverse events, including psoriasis. When managing psoriasis, induced or exacerbated by an ICI, there are concerns regarding immunosuppression from systemic agents for the treatment of psoriasis (saPs) and the potential impact on ICI efficacy. No direct, high-level evidence exists to address these concerns.ObjectiveTo address clinically relevant questions regarding the management of ICI-mediated psoriasis (ICI-Ps) with saPs.MethodsWe convened a multidisciplinary panel of 15 international specialists in dermatology, oncology, immunology, and rheumatology. A Delphi process defined clinical concerns related to the systemic treatment of ICI-Ps, focusing on the potential of saPs to impact ICI effectiveness. The saPs considered included biologics targeting tumour necrosis factor, interleukin (IL)-17, IL-12/23 and IL-23, traditional systemic therapies (cyclosporine, methotrexate), small molecules targeting phosphodiesterase-4 or tyrosine kinase 2, systemic retinoids (acitretin), and systemic corticosteroids. A systematic review of the literature was supplemented with evidence supporting an inference-based methodology to derive conclusions on the use of systemic therapies in patients with ICI-Ps. The specialist panel rated the strength of the conclusions using a probabilistic scale.ResultsAfter reviewing the totality of direct and indirect evidence, we drafted inference-based conclusions and ascribed a level of support, focusing on the potential impact of saPs on ICI efficacy. This work provides a structured framework informing healthcare professional and patient discussions on the risks and benefits of using saPs in patients with cancer who experience ICI-Ps.ConclusionsAlthough there is no direct evidence, we support the following conclusions: saPs may be used to treat ICI-Ps without an appreciable loss of ICI effectiveness. Generally, it is not necessary to interrupt ICI therapy. When available, non-steroid saPs are preferred over systemic corticosteroids for the treatment of psoriasis.
Filiaciones:
Papp, KA:
Prob Med Res Inc, Waterloo, ON, Canada
Alliance Clin Res, Waterloo, ON, Canada
Univ Toronto, Temerty Fac Med, Dept Dermatol, Toronto, ON, Canada
Puig, L:
Hosp Santa Creu & Sant Pau, Dept Dermatol, Barcelona, Spain
Inst Recerca St Pau IR SANT PAU, Barcelona, Spain
Univ Autonoma Barcelona, Fac Med, Barcelona, Spain
Beecker, J:
Prob Med Res Inc, Waterloo, ON, Canada
Univ Ottawa, Ottawa, ON, Canada
Ottawa Hosp, Div Dermatol, Ottawa, ON, Canada
Ottawa Hosp, Res Inst, Ottawa, ON, Canada
Chandran, V:
Univ Hlth Network, Schroeder Arthrit Inst,Krembil Res Inst, Ctr Prognosis Studies Rheumat Dis, Gladman Krembil Psoriat Arthrit Res Program, Toronto, ON, Canada
Univ Toronto, Dept Med, Div Rheumatol, Toronto, ON, Canada
Univ Toronto, Dept Lab Med & Pathobiol, Toronto, ON, Canada
Univ Toronto, Inst Med Sci, Toronto, ON, Canada
Claveau, J:
Ctr Hosp Univ Quebec, Melanoma & Skin Canc Clin, Hotel Dieu Quebec, Quebec City, PQ, Canada
Ctr Hosp Univ Quebec, Ctr Integre Cancerol, Quebec City, PQ, Canada
Cortes, J:
Med Scientia Innovat Res MEDSIR, Barcelona, Spain
Med Scientia Innovat Res MedSIR, Ridgewood, NJ USA
Int Breast Canc Ctr IBCC, Quiron Grp, Pangaea Oncol, Barcelona, Spain
Univ Europea Madrid, Fac Biomed & Hlth Sci, Dept Med, Madrid, Spain
Hosp Beata Maria Ana, Inst Oncol, IOB Madrid, Madrid, Spain
Hosp Univ Torrejon, Oncol Dept, Ribera Grp, Madrid, Spain
Dutz, J:
Arthrit Res Canada, Vancouver, BC, Canada
Vancouver Gen Hosp, Div Rheumatol, Vancouver, BC, Canada
BC Childrens Hosp, Res Inst, Vancouver, BC, Canada
Hornick, NI:
Oregon Hlth & Sci Univ, Dept Dermatol, Portland, OR USA
Juergens, RA:
McMaster Univ, Juravinski Canc Ctr, Dept Oncol, Hamilton, ON, Canada
Melosky, B:
BC Canc, Dept Med Oncol, Vancouver, BC, Canada
Univ British Columbia, Fac Med, Vancouver, BC, Canada
Patel, AB:
Univ Texas Houston, MD Anderson Canc Ctr, Dept Dermatol, Houston, TX USA
Univ Texas Houston, Hlth Sci Ctr, Dept Dermatol, Houston, TX USA
Sauder, MB:
Prob Med Res Inc, Waterloo, ON, Canada
Univ Toronto, Temerty Fac Med, Dept Dermatol, Toronto, ON, Canada
Sehdev, S:
Ottawa Hosp, Canc Ctr, Ottawa, ON, Canada
Univ Ottawa, Ottawa Hosp, Div Med Oncol, Ottawa, ON, Canada
Sibaud, V:
Oncopole Claudius Regaud, Dept Oncodermatol, Toulouse, France
Snow, SL:
Dalhousie Univ, Dept Med, Div Med Oncol, Halifax, NS, Canada
Green Submitted, hybrid
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