{"id":46879,"date":"2018-10-05T09:03:01","date_gmt":"2018-10-05T13:33:01","guid":{"rendered":"https:\/\/piel-l.org\/blog\/?p=46879"},"modified":"2018-10-05T23:11:09","modified_gmt":"2018-10-06T03:41:09","slug":"reacciones-cutaneas-adversas-comunes-y-no-tan-comunes-reportadas-con-el-tratamiento-de-ipilimumab","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/46879","title":{"rendered":"Reacciones cut\u00e1neas adversas, comunes y no tan comunes, reportadas con el tratamiento de Ipilimumab"},"content":{"rendered":"

Melanoma al D\u00eda.<\/b><\/span> <\/b><\/p>\n

Dra. Hilda V Ramos Zerpa<\/b>. <\/span>Dermat\u00f3logo.
\n<\/span>Dr. Ricardo Gonz\u00e1lez D\u00edaz<\/b>. <\/span>Cirujano Onc\u00f3logo<\/span>.
\n<\/span>Dr. Wilmer E Ramos Zerpa.<\/b> <\/span>Onc\u00f3logo.<\/span><\/p>\n

 <\/p>\n

El Ipilimumab es un medicamento que inhibe la v\u00eda de CTLA-4. Debido a su mecanismo de acci\u00f3n sobre\u00a0 <\/span>las c\u00e9lulas inmunes (efecto inmunomodulador) es probable\u00a0 <\/span>que con su uso se presenten varias reacciones medicamentosas adversas a piel y a otros \u00f3rganos.<\/span><\/p>\n

Se reporta una variedad de reacciones adversas dermatol\u00f3gicas<\/b> que ocurren en el 3 \u2013 68%\u00a0 <\/span>de los pacientes que reciben ipilimumab para el\u00a0 <\/span>tratamiento del Melanoma Metast\u00e1sico, como tambi\u00e9n para otros tipos de\u00a0 <\/span>tumores. <\/span>(1-5)<\/span><\/p>\n

Estas reacciones dermatol\u00f3gicas adversas son producto de un fen\u00f3meno dosis dependiente que generalmente ocurre entre la 2da y 12va\u00a0 <\/span>semana despu\u00e9s del inicio del tratamiento. <\/span><\/p>\n

Los eventos adversos dermatol\u00f3gicos m\u00e1s conocidos con el tratamiento de\u00a0 <\/span>ipilimumab incluyen: prurito, dermatitis morbiliforme, hipopigmentaci\u00f3n asociada con el melanoma similar al vit\u00edligo, sarcoidosis, y psoriasis. <\/span>(1,5,6,7)<\/span><\/p>\n

Se han informado otros\u00a0 <\/span>raros patrones de erupci\u00f3n relacionada con el f\u00e1rmaco, como lo son\u00a0 <\/span>las erupciones liquenoides, DRESS\u00a0 <\/span>(Reacci\u00f3n medicamentosa\u00a0 <\/span>con eosinof\u00edlia y s\u00edndromes y s\u00edntomas sist\u00e9micos )\u00a0 <\/span>y SSJ\u00a0 <\/span>( S\u00edndrome de Stevens-Johnson ) NET\u00a0 <\/span>(Necroliss Epid\u00e9rmica Toxica) <\/span>(8)<\/span><\/p>\n

Aunque las erupciones liquenoides a medicamentos\u00a0 <\/span>son t\u00edpicamente informados con\u00a0 <\/span>la administraci\u00f3n de\u00a0 <\/span>antibi\u00f3ticos, AINES,<\/b> inhibidores de la enzima convertidora de la angiotensina (ECA), antihistam\u00ednicos, medicamentos reductores de l\u00edpidos y sulfato de hidroxicloroquina, estas reacciones son m\u00e1s raras con medicamentos moduladores de la inmunidad como el anti-PD-1 y el anti-PD Clases de drogas L1 <\/span>. (7)<\/span><\/p>\n

Recientemente Alniemi DT y colaboradores <\/span>(11)<\/span> reportaron un caso caracterizado por\u00a0 <\/span>la presencia de una reacci\u00f3n liquenoide alrededor de los nevus melanociticos\u00a0 <\/span>(Nevus Halo Like) en un paciente con Melanoma metast\u00e1sico, recibiendo tratamiento con Ipilimumab. El paciente desarroll\u00f3\u00a0 <\/span>m\u00faltiples reacciones liquenoides en\u00a0 <\/span>halo alrededor de sus\u00a0 <\/span>nevus,\u00a0 <\/span>que histopatol\u00f3gicamente mostraron una dermatitis liquenoide de interface asociada con los nevus\u00a0 <\/span>ligeramente at\u00edpicos, adem\u00e1s de granulomas mal formados dentro del infiltrado.<\/span><\/p>\n

Libon y colaboradores <\/span>(10)<\/span> tambi\u00e9n reportaron un caso\u00a0 <\/span>con\u00a0 <\/span>un infiltrado liquenoide linfohistioc\u00edtico, no relacionado con nevus,\u00a0 <\/span>en un paciente que recibi\u00f3 ipilimumab. <\/span><\/p>\n

Seg\u00fan Downey <\/span>(9)<\/span> y colaboradores, se encontr\u00f3 un aumento de la eficacia del tratamiento con ipilimumab en pacientes que desarrollaron efectos adversos relacionados con el sistema inmunitario (26% respondi\u00f3 al tratamiento) en comparaci\u00f3n con aquellos sin efectos adversos relacionados con el sistema inmunitario (en el que solo\u00a0 <\/span>2% respondi\u00f3).\u00a0<\/span><\/p>\n

A medida que se ampl\u00eda la era de los f\u00e1rmacos inmunomoduladores para su uso en\u00a0 <\/span>oncolog\u00eda, los m\u00e9dicos debemos\u00a0 <\/span>ser conscientes de las reacciones adversas que se puedan generar.<\/span><\/p>\n

Los dermat\u00f3logos tienen\u00a0 <\/span>un papel \u00a0 <\/span>muy importante en el monitoreo de estas reacciones adversas, ya que los Eventos Dermatol\u00f3gicos Adversos tienen un inicio m\u00e1s\u00a0 <\/span>temprano \u00a0 <\/span>en comparaci\u00f3n con los\u00a0 <\/span>efectos\u00a0 <\/span>a otros\u00a0 <\/span>\u00f3rganos.<\/span><\/p>\n

Tambi\u00e9n vale la pena se\u00f1alar que para la mayor\u00eda de los pacientes, los efectos dermatol\u00f3gicos adversos\u00a0 <\/span>son relativamente leves y se tratan con \u00e9xito,\u00a0 <\/span>sin\u00a0 <\/span>necesidad de interrumpir el tratamiento.<\/span><\/p>\n

Bibliografia.<\/span><\/p>\n

    \n
  1. deGolian \u00a0 <\/span>E, \u00a0 <\/span>Kwong \u00a0 <\/span>BY, \u00a0 <\/span>Swetter \u00a0 <\/span>SM, \u00a0 <\/span>Pugliese \u00a0 <\/span>SB.Cutaneous Complications\u00a0 <\/span>of\u00a0 <\/span>Targeted\u00a0 <\/span>Melanoma\u00a0 <\/span>Therapy. Curr Treat Options Oncol. 2016;17(11):57. [PMID: 27645330]<\/span><\/li>\n
  2. Kahler KC, Hauschild A.Treatment and side effect management of CTLA-4 \u00a0 <\/span>antibody \u00a0 <\/span>therapy \u00a0 <\/span>in \u00a0 <\/span>metastatic \u00a0 <\/span>melanoma. J\u00a0 \u00a0 <\/span>Dtsch Dermatol Ges. 2011;9(4):277-86. [PMID: 21083648<\/span><\/li>\n
  3. Weber JS, Kahler KC, Hauschild A.Management of immune-related adverse\u00a0 <\/span>events\u00a0 <\/span>and\u00a0 <\/span>kinetics\u00a0 <\/span>of\u00a0 <\/span>response\u00a0 <\/span>with\u00a0 <\/span>ipilimumab. J\u00a0 <\/span>Clin Oncol. 2012;30(21):2691-97. [PMID: 22614989]<\/span><\/li>\n
  4. Wolchok JD, Hodi FS, Weber JS, et al.Development of ipilimumab: a \u00a0 <\/span>novel \u00a0 <\/span>immunotherapeutic \u00a0 <\/span>approach \u00a0 <\/span>for \u00a0 <\/span>the \u00a0 <\/span>treatment \u00a0 <\/span>of advanced\u00a0 <\/span>melanoma. Ann\u00a0 <\/span>N\u00a0 <\/span>Y\u00a0 <\/span>Acad\u00a0 <\/span>Sci. 2013;1291:1-13.\u00a0 <\/span>[PMID: 23772560]<\/span><\/li>\n
  5. Ibrahim\u00a0 <\/span>RA,\u00a0 <\/span>Berman\u00a0 <\/span>DM,\u00a0 <\/span>DePril\u00a0 <\/span>V,\u00a0 <\/span>et\u00a0 <\/span>al.Ipilimumab\u00a0 <\/span>safety\u00a0 <\/span>profile: summary\u00a0 \u00a0 <\/span>of\u00a0 \u00a0 <\/span>findings\u00a0 \u00a0 <\/span>from\u00a0 \u00a0 <\/span>coompleted\u00a0 \u00a0 <\/span>trials\u00a0 \u00a0 <\/span>in\u00a0 \u00a0 <\/span>advanced melanoma\u00a0 <\/span>[abstract\u00a0 <\/span>8583]. J\u00a0 <\/span>Clin\u00a0 <\/span>Oncol. 2011;29(15\u00a0 <\/span>suppl).\u00a0 <\/span>DOI: 10.1200\/jco.2011.29.15_suppl.8583.<\/span><\/li>\n
  6. Reyes-Habito CM, Roh EK.Cutaneous reactions to chemotherapeutic drugs and targeted therapies for cancer: Part II. Targeted \u00a0 <\/span>therapy. J \u00a0 <\/span>Am \u00a0 <\/span>Acad \u00a0 <\/span>Dermatol. 2014;71(2): \u00a0 <\/span>217.e1-11. [PMID: 25037801<\/span><\/li>\n
  7. Magro CM, Crowson AN.Lichenoid and granulomatous dermatitis. Int J Dermatol. 2000;39(2);126-33. [PMID: 10692062]<\/span><\/li>\n
  8. Lacouture\u00a0 <\/span>ME,\u00a0 <\/span>Wolchok\u00a0 <\/span>JK,\u00a0 <\/span>Yosipovitch\u00a0 <\/span>G,\u00a0 <\/span>Kahler\u00a0 <\/span>CK,\u00a0 <\/span>Busam\u00a0 <\/span>KJ, Hauschild\u00a0 \u00a0 <\/span>A.Ipilimumab\u00a0 \u00a0 <\/span>in\u00a0 \u00a0 <\/span>patients\u00a0 \u00a0 <\/span>with\u00a0 \u00a0 <\/span>cancer\u00a0 \u00a0 <\/span>and\u00a0 \u00a0 <\/span>the management of dermatologic adverse events. J Am Acad Dermatol. 2014;71;161-9. [PMID: 24767731<\/span><\/li>\n
  9. Downey SG, Klapper JA, Smith FO, et al.Prognositc factors related to clinical response in patients with metastatic melanoma treated by \u00a0 \u00a0 <\/span>CTL-associated \u00a0 \u00a0 <\/span>antigen-4 \u00a0 \u00a0 <\/span>blockade. Clin Cancer Res. 2007;13:6681-88. [PMID: 1798212<\/span><\/li>\n
  10. Libon \u00a0 <\/span>F, \u00a0 <\/span>Arrese \u00a0 <\/span>JE, \u00a0 <\/span>Rorive \u00a0 <\/span>A, \u00a0 <\/span>Nikkels \u00a0 <\/span>AF.Ipilimumab \u00a0 <\/span>induces simultaneous \u00a0 <\/span>regression \u00a0 <\/span>of \u00a0 <\/span>melanocytic \u00a0 <\/span>naevi \u00a0 <\/span>and \u00a0 <\/span>melanoma metastases. Clin Exp Dermatol. 2013;38(3);276-9. [PMID: 23020081].<\/span><\/li>\n
  11. Dema T Alniemi MD, Alyssa Fischer MD, Laura A Greene MD, Joseph C Pierson MD Dermatology Online Journal.<\/span> Volume 24Number 7| July2018|24(7):5-1-<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    El Ipilimumab es un medicamento que inhibe la v\u00eda de CTLA-4. Debido a su mecanismo de acci\u00f3n sobre las c\u00e9lulas inmunes (efecto inmunomodulador) es probable que con su uso se presenten varias reacciones medicamentosas adversas a piel y a otros \u00f3rganos<\/p>\n","protected":false},"author":54,"featured_media":46880,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[415],"tags":[],"class_list":["post-46879","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-melanoma-al-dia"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/46879","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/users\/54"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=46879"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/46879\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media\/46880"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=46879"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=46879"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=46879"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}