Infliximab Assessed as Potential Treatment for PD-1-Induced Psoriasis

A recent research letter indicated that infliximab should be further researched as a potential treatment for psoriasis in those being given anti-programmed death 1 (PD-1) agents.

The letter’s 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.

The PD-1 inhibitor known as pembrolizumab works as an immune checkpoint inhibitor (ICI). ICIs have been established in physicians’ treatment of malignant melanoma (MM) and have also been known to improve prognosis in advanced tumor stages, though possible immune-related adverse events (irAEs) such as psoriasis may 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,” Hansen and colleagues wrote. “The spectrum of cutaneous irAE is diverse and most commonly present as maculopapular exanthema with pruritus. Another possible manifestation is psoriasis.”

The investigators sought to examine a patient with stage II malignant melanoma and psoriasis by testing out several treatments, eventually assessing the use of infliximab after the results from previous treatments.

The research team noted that TNF-alpha inhibitors had previously been established for the treatment of conventional psoriasis and used for therapy of irAE colitis in steroid-refractory cases.

Findings

The investigators began a systemic therapy on their patient using the TNF-alpha inhibitor known as infliximab, at a dose of 5mg per kg. Following a 5-dose treatment, the patient’s skin lesions were found to have almost entirely resolved and led to a PASI-90 score.

They also found that in their stage-specific follow-up examinations on the patient’s MM, they observed 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,” they 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.”

The letter, “Successful Treatment of PD-1 Inhibitor-induced Psoriasis with Infliximab,” was published in the Journal of the European Academy of Dermatology and Venereology.