A Study of Immune Checkpoint Inhibitors & Complication Rates

Charles Puza, MD, a post-graduate dermatology resident at the University of Texas Southwestern in Dallas, Texas, presented research data on the safety and complications of immune checkpoint inhibitors with dermatologic procedures in an oral abstract at the American Society for Dermatologic Surgery Meeting. The objective of the study was to determine postoperative complications in patients undergoing dermatologic procedures while receiving immune checkpoint inhibitors.

“As background, in 2011, ipilimumab was the first medication in this class granted FDA approval for metastatic melanoma. Since then, immune checkpoint inhibitors have continued to expand, and the indications have as well, including squamous cell carcinoma, Merkel cell carcinoma, lung cancer, hepatocellular carcinoma, renal cell cancer, urogenital cancer, and many other rare conditions,” said Puza.

According to the study, the adverse effects related to this class of medications are related to immune system activation, including colitis, hepatitis, and pneumonitis. The safety of dermatologic procedures and postoperative complications in these patients has yet to be studied.

The study was a single center, retrospective, and examined patients from January 2015 through June 2021, allowing for a 6-month follow-up period. All patients were actively receiving immune checkpoint inhibitors at the time of dermatologic surgery, which included Mohs surgery and excisions. Biopsies or intralesional injections were not included.

Puza and his colleagues continuously reviewed the indications for immune checkpoint inhibitor therapy, patient demographics, and postoperative complications. Twenty-five patients fit the criteria of the study. The majority were male, and the mean age was 64.3. Overall, the 25 patients underwent 48 dermatologic procedures, ranging from excision with immediate closure to electrodesiccation and curettage.

The indications for immune checkpoint inhibitors mainly included melanoma, lung cancer, bladder cancer, and bile duct cancer. Regarding procedural locations, approximately half of the patients received a procedure on the head or neck, with the 2nd half of patients in the extremity and trunk group.

Nivolumab was the most common immune checkpoint inhibitor used in this study, received by 16 patients. Pembrolizumab was the 2nd most common with 5 patients, and 3 patients received a combination of ipilimumab and nivolumab.

“Overall complications were rare in this cohort. Again, this [study] is extremely small, but infection was identified in 2 patients and treated with oral antibiotics without complication. One patient had significant enough pain to require an emergency department visit. Neither recurrence nor postoperative bleeding was reported in the follow-up period.

“To conclude, immune checkpoint inhibitor therapy does not appear to dramatically increase the rates of complications in patients undergoing dermatologic procedures. Although this was a small study, dermatologic surgery, including Mohs micrographic surgery, was safe and well tolerated in this small sampling of patients.”

Reference:

1. Puza C, Pyle H, Srivastava D, Nijhawan R. Immune checkpoint inhibitors and dermatologic procedures: A retrospective review of safety and complications. Presented at: 2022 American Society of Dermatologic Surgery Annual Meeting, Denver Colorado, October 7-10, 2022.