Women were approximately twice as likely as men to develop dermatological adverse events while taking immune checkpoint inhibitors for metastases. melanoma in a review of 235 patients at the Dana Farber Cancer Center, Boston, Massachusetts.
Overall, 62.4% of the 93 women in the review and 48.6% of the 142 men experienced confirmed skin reactions, with a probability ratio (OR) of 2.11 compared to men (Pg = .01).
“Clinicians should consider these findings in advising female patients on a high risk of dermatological adverse events” when taking checkpoint inhibitors, said researchers led by Harvard University medical student Jordan Said, who presented the results at the American Academy of Dermatology Virtual Meeting Experience.
Autoimmune-like adverse events are common with checkpoint inhibitors. Dermatological side effects occur in approximately half of people receiving monotherapy and more than in patients receiving combination therapy.
Skin reactions may include psoriatic dermatitis, lichenoid reactions, vitiligo, and bullous pemphigoid and may require hospitalization and prolonged steroid treatment.
Not much is known about the risk factors for these reactions. A higher incidence has been reported among women. A 2019 study a higher risk of pneumonitis and endocrinopathy, including pituitary gland, was found among women who were treated for non-small cell lung cancer or metastatic melanoma.
The 2019 study found that the risk was higher among premenopausal women than postmenopausal women, which led some to suggest this. estrogens can play a role.
The results of Dana Farber’s review argue against this notion. In their review, the researchers found that the risk was similarly high among the 27 premenopausal women (OR, 1.97; Pg = 0.40) and the 66 postmenopausal women (OR, 2.17, Pg = 0.05). In the study, women who were 52 years of age or older at the start of treatment were considered to be postmenopausal.
“This suggests that factors beyond sex hormones are likely to contribute” to the difference in risk between men and women. It is known that women are at higher risk for autoimmune diseases in general, which could be related to the increased likelihood of autoimmune-like reactions, and it may be that sex-related differences in innate immunity and adoptive parents are working, Said said.
When asked for a comment, Douglas Johnson, MD, assistant professor of hematology / oncology at Vanderbilt University, Nashville, Tennessee, said that while some studies have reported an increased risk of side effects among women, others have not. “Additional research is needed to determine the interactions between sex and the effects of immune checkpoint inhibitors, as well as many other possible triggers of immune-related adverse events.”
“Continued work in this area will be just as important to help determine how best to advise women and ensure early recognition and intervention of dermatological side effects,” she said. Bernice Kwong, MD, director of the Dermato-Oncology Support Program at Stanford University, Stanford, California.
Patients in the review were treated from 2011 to 2016 and underwent monthly evaluations by their medical team. They were taking either nivolumab, pembrolizumab, o ipilimumab or a nivolumab / ipilimumab combination.
The mean age of the men in the study was 65; the average age of women was 60 years. Almost 98% of the participants were white. Most received one to three infusions, most frequently with pembrolizumab monotherapy.
No funding for the study was reported. Said has not disclosed any relevant financial relationship.
Experience of virtual meetings of the American Academy of Dermatology (AAD VMX) 2021.
M. Alexander Otto is an award-winning physician assistant and medical journalist who has previously worked for several major media outlets, including McClatchy and Bloomberg BNA. He is a former MIT Knight science journalism fellow. E-mail: [email protected].