Introduction Discussion

Objectives

Conclusions

1. Barbosa NS, Wetter DA, Wieland CN, Shenoy NK, Markovic SN, Thanarajasingam U. Scleroderma Induced by Pembrolizumab: A Case Series. Mayo Clin Proc. 2017;92(7):1158-1163.10.

2. Tjarks BJ, Kerkvliet AM, Jassim AD, Bleeker JS. Scleroderma-like skin changes induced by checkpoint inhibitor therapy. J Cutan Pathol. 2018;45(8):615-618.3. Sheik Ali S, Goddard AL, Luke JJ, et al. Drug-associated dermatomyositis following ipilimumab therapy: a novel immune-mediated adverse event associated with cytotoxic T-lymphocyte antigen 4 blockade. JAMA Dermatol. 2015;151(2):195-199.4. Blakeway EA, Elshimy N, Muinonen-Martin A, Marples M, Mathew B, Mitra A. Cutaneous lupus associated with pembrolizumab therapy for advanced melanoma: a report of three cases. Melanoma Res. 2019;29(3):338-341.5. Liu RC, Sebaratnam DF, Jackett L, Kao S, Lowe PM. Subacute cutaneous lupus erythematosus induced by nivolumab. Australas J Dermatol. 2018;59(2):e152-e154.6. Zitouni NB, Arnault JP, Dadban A, Attencourt C, Lok CC, Chaby G. Subacute cutaneous lupus erythematosus induced by nivolumab: two case reports and a

literature review. Melanoma Res. 2019;29(2):212-215.

Disclosures: None declared.

References

Results

Cutaneous Connective Tissue Disease Associated withImmune Checkpoint Inhibitor Therapy: A Retrospective Analysis

Ai-Tram N. Bui, B.A.1, Jesse Hirner, M.D.2, Sean Singer, B.S.1, Kiki Cunningham-Bussel M.D., P.h.D.3, Cecilia LaRocca, M.D.2,4, Christine G. Lian, M.D.5,Joseph F. Merola, M.D.2, Nicole R. LeBoeuf, M.D., M.P.H.2,4

1Harvard Medical School, Boston, MA, 2Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, 3Department of Rheumatology, Brigham and Women’s Hospital, Boston, MA, 4Center for Cutaneous Oncology, Department of Dermatology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, 5Department of Pathology, Brigham and Women’s Hospital, Boston, MA

• Immune checkpoint inhibitors (ICIs) are associated with distinct inflammatory eruptions such as bullous pemphigoid or lichenoid eruptions1.

• Less is known about the development of autoimmune/autoinflammatory disorders including cutaneous connective tissue diseases (CTD) from immunotherapy;frequency of these eruptions remain to bestudied1.

• There are reports of de novo cutaneous connective tissue diseases (CTD) associated with ICI therapy including scleroderma, dermatomyositis, cutaneous lupus, eosinophilic fasciitis, and lupus nephritis1-6.

To evaluate the frequency, demographics, presentation, diagnostics, treatment, and impact on immunotherapy of de novo cutaneous CTD

among patients on ICIs.

Methodology• After institutional review board approval, we

queried electronic medical records and found 4,487 patients on ICI therapy.

• We retrospectively reviewed and identified patients among this cohort who had possible de novo cutaneous CTD after ICI therapy.

• We searched for patients with de novoscleroderma, systemic sclerosis, dermatomyositis, cutaneous lupus, subacute cutaneous lupus, systemic lupus erythematosus, eosinophilic fasciitis, and discoid lupus.

• We identified 11 patients of 4,487 patients (5 females, 6 males) treated with ICIs and developed a cutaneous CTD for frequency of 0.025%.There were 8 cases of subacute cutaneous lupus erythematosus (SCLE), 1 case meeting the new ACR/EULAR criteria for systemic lupus erythematosus (SLE), 1 case of eosinophilic fasciitis, and 1 case of dermatomyositis (Table 1).

Pt Age,Sex Cancer & Stage ICI & onsetAutoantibody

& pertinent laboratory markers

Histopathology & Direct Immunofluorescence

ICI Interruption

Subacute cutaneous lupus erythematosus cases

1 54, FLung, small cell, IV

NivolumabANA: 1:5120, speckledAnti-Ro(SSA): >8.0Anti-La(SSB): >8.0

HE: mild focal interface dermatitis changesDIF: N/P

Not interrupted

2 54, F Ovarian, IV PD-1 inhibitor

ANA: 1:80Anti-Ro(SSA): 8.0Anti-La(SSB): 0.4

HE: lichenoid dermatitis with prominent interface changes and bullous formation, with damaged keratinocytes and colloid bodiesDIF: wnl

Not interrupted by SLE, held for ICI-associated acute kidney injury and restarted at full dose 1 mo later

5 65, M Lung, small cell Pembrolizumab

ANA: 1:320, speckledAnti-Ro(SSA): >8.0Anti-La(SSB):