Insights from Jason Hawkes, MD, MS, on Immune Checkpoint Inhibitors

At the Elevate Derm West Conference, Jason Hawkes, MD, MS, an investigator at the Oregon Medical Research Center, joined James Song, MD, FAAD, to discuss the growing overlap between oncology and dermatology, particularly regarding the effects of immune checkpoint inhibitors (ICIs). In their session, they explored the mechanisms, challenges, and management of dermatological toxicities associated with these groundbreaking cancer therapies.

Hawkes explained that ICIs work by blocking inhibitory immune pathways, effectively "activating" the immune system to target cancer cells. However, this heightened immune activity often triggers unintended skin-related adverse events, including new or worsened autoimmune conditions such as psoriasis, eczema, alopecia areata, vitiligo, and bullous pemphigoid. He said dermatology clinicians must now be prepared to recognize and manage these toxicities, even if they aren't directly prescribing ICIs.

He emphasized the delicate balancing act required in treating these patients. While oncologists aim to maintain an overactive immune system to combat cancer, dermatologists often need to suppress immune responses to manage skin conditions. This conflicting goal makes treatment complex, as broad immunosuppressants like corticosteroids may interfere with cancer therapies.

To navigate this, Hawkes highlighted the promise of targeted therapies, such as dupilumab, which can address dermatological symptoms like rashes and itching without significantly compromising the immune response needed for cancer treatment. He also stressed the importance of integrating these therapies into multidisciplinary care plans, ensuring dermatologists and oncologists align their strategies.

The session concluded with a call for clinicians to stay informed about ICIs, as these therapies are becoming increasingly prevalent. He stated collaboration between specialties and a clear understanding of how to manage mild to severe cutaneous toxicities will be essential for optimizing patient outcomes. Hawkes and Song's discussion underscored the importance of ongoing research and dialogue in this evolving area of medicine.