Histopathologic Insights and Treatment Outcomes in PD-1 and PDL-1 Cutaneous Immune-Related Adverse Events: A Case Series
DOI:
https://doi.org/10.5195/ijms.2026.3588Keywords:
apremilast, anti-PD-1, anti-PDL-1, dupilumab, immune checkpoint inhibitors, lichenoid eruptions, psoriasiform rash, pembrolizumab, atezolizumab, case reportAbstract
Background: Immune checkpoint inhibitors (ICIs), including therapies targeting anti-programmed cell death protein 1 (PD-1) or anti-programmed death-ligand 1 (PDL-1), are highly effective for treating various malignancies, but are often associated with immune-related adverse events (irAEs). Among these, cutaneous irAEs are the most prevalent, affecting about half of patients and varying widely in severity. irAEs can impact quality of life and lead to treatment discontinuation. Managing these side effects effectively is essential to allow continuation of therapy without compromising its efficacy.
Methods: Retrospective case series.
Results: We present three patients who developed severe cutaneous irAEs: two with pembrolizumab-induced lichenoid dermatitis and one with atezolizumab-induced psoriasiform rash. Initial treatment was guided by histopathologic findings, leading to the use of dupilumab, an interleukin-4 receptor (IL-4Ra) monoclonal antibody, in all three cases. While two patients achieved full resolution with dupilumab, the third case, which progressed to a clinically psoriasiform morphology, was later treated with apremilast, a phosphodiesterase 4 (PDE4) inhibitor, resulting in significant improvement.
Conclusion: These cases highlight the critical role of combining histopathologic and clinical insights to customize treatment approaches. Both dupilumab and apremilast are steroid-sparing options with favorable safety profiles and offer effective alternatives to systemic corticosteroids without compromising the efficacy of ICIs.
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