Immunohistochemical analysis of lichenoid reactions in patients treated with anti-PD-L1 and anti-PD-1 therapy

Kurt B. Schaberg, Roberto A. Novoa, Heather A. Wakelee, Jinah Kim, Christine Cheung, Sandhya Srinivas, Bernice Y. Kwong

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background Recent advances in the immunotherapeutic treatment of cancer have led to the development of multiple new directed therapies including monoclonal antibodies that block the immune checkpoint T-cell receptor programmed death 1 (PD-1) and the PD-1 ligand, programmed death ligand 1 (PD-L1). Various immune-related toxicities have been associated with these drugs including, most commonly, skin rashes. Methods Five cases of lichenoid dermatitis, including one case of lichenoid mucositis and one case of lichen sclerosus, associated with anti-PD-L1 and anti-PD1 therapy were compared with three biopsies of non-drug-related lichen planus (LP) and three lichen planus-like keratoses (LPLK) used as controls. Results Histopathologic and immunophenotypic analysis of these lichenoid lesions demonstrated significantly greater histiocytic infiltrates than observed in control lichenoid reactions (p = 0.0134). We also observed increased spongiosis and epidermal necrosis. No significant differences were seen in expression of CD3, CD4:CD8, CD20, PD-1, CD25, Foxp3, CXCL13 and PD-L1 expression. Conclusions These findings expand the literature of immune-related toxicities of PD-L1 and PD-1 blockade to include lichenoid dermatitis and lichenoid mucositis. Of note, these cutaneous side effects were amenable to topical treatment, without the need for medication dose reduction or discontinuation.

Original languageEnglish (US)
Pages (from-to)339-346
Number of pages8
JournalJournal of Cutaneous Pathology
Volume43
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Fingerprint

Ligands
Lichen Planus
Mucositis
Dermatitis
Therapeutics
Lichen Sclerosus et Atrophicus
Keratosis
T-Cell Antigen Receptor
Exanthema
Necrosis
Monoclonal Antibodies
Biopsy
Skin
Pharmaceutical Preparations
Neoplasms

Keywords

  • drug reaction
  • immunotherapy
  • lichenoid reaction
  • programmed death 1
  • programmed death ligand 1

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology
  • Dermatology

Cite this

Immunohistochemical analysis of lichenoid reactions in patients treated with anti-PD-L1 and anti-PD-1 therapy. / Schaberg, Kurt B.; Novoa, Roberto A.; Wakelee, Heather A.; Kim, Jinah; Cheung, Christine; Srinivas, Sandhya; Kwong, Bernice Y.

In: Journal of Cutaneous Pathology, Vol. 43, No. 4, 01.04.2016, p. 339-346.

Research output: Contribution to journalArticle

Schaberg, Kurt B. ; Novoa, Roberto A. ; Wakelee, Heather A. ; Kim, Jinah ; Cheung, Christine ; Srinivas, Sandhya ; Kwong, Bernice Y. / Immunohistochemical analysis of lichenoid reactions in patients treated with anti-PD-L1 and anti-PD-1 therapy. In: Journal of Cutaneous Pathology. 2016 ; Vol. 43, No. 4. pp. 339-346.
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