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SHORT COMMUNICATION
Two Cancer Patients Receiving Dupilumab for Treatment of Atopic Dermatitis
Emilie FOWLER 1,2 , Jordan ROSEN 1,2 , Hadar LEV-TOV 1 and Gil YOSIPOVITCH 1,2 *
Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, and 2 Miami Itch Center, University of Miami Miller School of Medicine,
1600 NW 10 th Ave, RMSB 2067B, Miami, FL, 33136, USA. *E-mail: [email protected]
1
Accepted Apr 29, 2019; E-published Apr 29, 2019
Dupilumab is the first monoclonal antibody approved
for treatment of atopic dermatitis. Dupilumab targets the
alpha subunit of interleukin-4 (IL-4) receptor, thereby
interfering with IL-4 and IL-13 signaling (1). Long-term
safety data for dupilumab is still lacking and clinical
studies did not include patients with cancer. Current
non-specific systemic immunosuppressive therapies
for atopic dermatitis raise safety concerns when used
in patients with advanced cancer. Here, we present two
patients with advanced cancer receiving dupilumab with
no evidence of cancer recurrence.
CASE REPORTS
Case 1. A 22-year-old woman with a history of intermit-
tent asthma, poorly controlled atopic dermatitis since
infancy, and a new diagnosis of melanoma presented
with severe eczema with over 40% of body surface area
involvement and eczema area and severity index (EASI)
score of 62. The melanoma had a Breslow thickness of
5 mm. The patient received wide-localized excision and
sentinel lymph node biopsy, which was positive.
She reported being extremely bothered by pruritus
(numerical rating scale (NRS) 10/10) and inability to
sleep. The symptoms were so severe that the patient had
opted against adjuvant immunotherapy for her melanoma
because of the risk of recrudescence of eczema. Instead,
she opted for clinical and imaging surveillance.
The patient’s initial regimen included wet wraps,
topical mometosone 0.075% in silicone, crisaborole,
and low dose mirtazapine at night. This regimen was
minimally effective. After discussions with the patient,
dermatologist, and oncologist, dupilumab was initiated.
After one month of treatment with dupilumab, the
severity of pruritus significantly lessened (NRS 3/10),
her EASI score decreased to 1.8, and only minimal
eczematous plaques were present on the lower extre-
mities. At the most recent follow-up visit – 18 months
of treatment – the patient denied any pruritus, and
physical examination was only remarkable for mild
lichenification of the lower extremities. Fig. 1 shows
her progressive improvement on dupilumab after 15
months of treatment. The patient is following up with
oncology, and clinical exams and surveillance imaging
are negative to-date.
Case 2. A 43-year-old man with a history of atopic
dermatitis, human immunodeficiency virus (HIV) on
antiretroviral therapy, and anal squamous cell carcinoma
(SCC) presented with severe pruritus (NRS 10/10) and a
diffuse, eczematous eruption on his arms and trunk. The
patient was recently diagnosed with stage IIIb anal SCC
and received chemotherapy and radiation. Six months
after completing treatment, follow-up PET scan images
were distorted due to his severe dermatitis.
Considering his HIV and recent anal SCC, a variety
of topical medications including clobetasol 0.05% oint-
ment, triamcinolone 0.1% ointment, and pimecrolimus
1% cream, were prescribed in combination with narrow-
band UVB phototherapy. However, the condition did not
improve, and he continued to experience frequent flares
and developed secondary methicillin-resistant Staphy-
lococcus aureus (MRSA) impetigizination requiring
antibiotics. Given the severity of his atopic dermatitis,
the impact on quality of life, and interference with cancer
screening, dupilumab was initiated in coordination with
his primary care provider and oncologist.
Two weeks after his first injection of dupilumab, the
patient’s pruritus was significantly improved (NRS 4/10),
and physical examination revealed only lichenified skin
and healed scars (Fig. 2). Additionally, biopsies of sus-
Fig. 1. Patient 1: (a) Posterior
b i l a t e ra l k n e e s w i t h m i l d
lichenification after one month of
treatment with dupilumab. (b) The
back after 4 months of treatment
with dupilumab showing scattered
patches of postinflammatory
hyperpigmentation and mild
lichenification; and (c) back
of patient after 15 months of
treatment with dupilumab with
mild postinflammatory hyper
pigmentation.
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3201
Acta Derm Venereol 2019; 99: 899–900