Ipilimumab induced digital vasculitis

Immune check point inhibitors (ICIs) have emerged as a new therapeutic paradigm for a variety of malignancies including metastatic melanoma. As the use of ICIs expand, immune-mediated adverse events are becoming a common occurrence. We describe the first reported patient with small vessel vasculitis...

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Bibliographic Details
Published in:Journal for immunotherapy of cancer 2018-02, Vol.6 (1), p.12-5, Article 12
Main Authors: Padda, Amrita, Schiopu, Elena, Sovich, Justin, Ma, Vincent, Alva, Ajjai, Fecher, Leslie
Format: Article
Language:English
Subjects:
Antibodies
Antineoplastic Agents, Immunological - adverse effects
Cancer
Cancer metastasis
Care and treatment
Case Report
Complications and side effects
Disease prevention
FDA approval
Female
Hepatitis
Humans
Immune related adverse events (IRAEs)
Immunosuppressive agents
Immunotherapy
Inflammatory bowel disease
Ipilimumab
Ipilimumab - adverse effects
Ischemia
Lymphatic system
Melanoma
Melanoma - drug therapy
Metastasis
Middle Aged
Monoclonal antibodies
Neutrophils
Pain
Patients
Rituximab
Skin Neoplasms - drug therapy
Steroids
Targeted cancer therapy
Vasculitis
Vasculitis - chemically induced
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Summary:Immune check point inhibitors (ICIs) have emerged as a new therapeutic paradigm for a variety of malignancies including metastatic melanoma. As the use of ICIs expand, immune-mediated adverse events are becoming a common occurrence. We describe the first reported patient with small vessel vasculitis, manifested by digital ischemia, following treatment with high dose Ipilimumab for resected stage IIIB/C melanoma. This patient received high dose steroids, five-day intravenous (IV) Epoprostenol protocol, botulinum toxin injections, and Rituximab 375 mg/m weekly for four cycles. With this treatment regimen, the digital ischemia did not progress proximally, but she did require multiple distal digit amputations about six months after the onset of her symptoms. Prompt identification and management of immune related adverse events (IRAEs) are critical to optimal patient management. This patient's vasculitis did not reverse, but was likely halted and stabilized with multiple immunosuppressive medications.
ISSN:2051-1426
2051-1426
DOI:10.1186/s40425-018-0321-2