Treatment with immune checkpoint inhibitors have the potential for immune-related adverse events, such as psoriasis.
Infliximab may be a potential treatment option for psoriasis in patients undergoing therapy with anti-programmed cell death protein 1 (PD-1) agents, according to a research letter published in the Journal of the European Academy of Dermatology and Venereology.
The research into infliximab was led by Inga Hansen, MD, of the Department of Dermatology and Venereology, University Skin Cancer Center Hamburg at the University Medical Center Hamburg-Eppendorf. PD-1 inhibitors, such as pembrolizumab, work as an immune checkpoint inhibitor (ICI).
ICIs have been previously established in the treatment of malignant melanoma (MM) and have been found to improve prognosis in advanced tumor stages; however, there is the potential for immune-related adverse events (irAEs), such as psoriasis, to occur.
“In patients receiving monotherapy with a PD-1 inhibitor, grade 3 or 4 irAEs occurred in 23% with nivolumab and in 16% with pembrolizumab,” the investigators wrote. “The spectrum of cutaneous irAE is diverse and most commonly present as maculopapular exanthema with pruritus. Another possible manifestation is psoriasis.”
The researchers evaluated a patient with stage II malignant melanoma and psoriasis by testing several treatments before assessing the use of infliximab following the results from previous treatments. The researchers noted that TNF-alpha inhibitors were previously established in the treatment of conventional psoriasis and for therapy of irAE colitis in steroid-refractory cases.
The researchers initiated a systemic therapy on the patient using infliximab at a dose of 5 mg per kg. After a 5-dose treatment, the patient’s skin lesions were observed to have almost entirely been resolved with a PASI-90 score. In the stage-specific follow-up examinations on the patient’s MM, the investigators found no tumor progression in the patient.
“TNF is produced by cancer cells and favors a proinflammatory microenvironment and thus immunoregulatory responses that promote cancer cell proliferation, tumor angiogenesis, and metastasis,” the investigators wrote. “Preclinical studies have already demonstrated that TNF blockade can promote tumor regression and ICI efficacy. A potentially improved response to ICI with the additional administration of TNF-alpha inhibitors, as well as safety of use, was confirmed in the TICIMEL-study for Certolizumab and should be investigated in future studies.”
Hansen I, Heidrich I, Abeck F, et al. Successful treatment of PD-1 inhibitor-induced psoriasis with infliximab. J Eur Acad Dermatol Venereol. Published online 2022. doi:10.1111/jdv.18780.