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COVID-19 and Lung Cancer: Skin Manifestations With Immunotherapy

By: Joseph Fanelli
Posted: Friday, September 18, 2020

Two case studies, published in the Journal of Thoracic Oncology, present a pair of patients with non–small cell lung carcinoma (NSCLC) who became infected with COVID-19 and developed atypical and severe skin manifestations during long-term immunotherapy. Oscar Arrieta, MD, of the Instituto Nacional de Cancerología, Mexico City, and colleagues found that immune checkpoint inhibition yielded a “major response,” and neither of the patients had previous dermatologic conditions.

“No unique reason exists to expect that patients with COVID-19 infection will benefit from corticosteroids, especially in the setting of acute respiratory distress syndrome; however, in the presence of other manifestations, an alternative perspective may be useful,” the authors noted.

The first patient, a 62-year-old man, was diagnosed with stage IV squamous cell lung carcinoma with pleuropulmonary involvement in 2017. He was previously treated with ipilimumab plus nivolumab, followed by an immunotherapy combination. In March 2020, researchers confirmed the man had COVID-19. He developed an urticarial reaction in relation to the infection, and a clinical evaluation suggested the coexistence of dermatographism and cholinergic urticaria. At the time of publication, the patient was asymptomatic, with no sign of injury to the skin or joints.

The second patient, a 58-year-old woman, was diagnosed with NSCLC in 2019. She was previously treated with carboplatin, pemetrexed, and pembrolizumab; stereotactic radiosurgery for two residual brain metastases; and then pemetrexed and pembrolizumab maintenance. In March 2020, she tested positive for COVID-19. A skin biopsy revealed necrotic keratinocytes, with the epidermis and an interface dermatitis consistent with erythema multiforme. The patient received hydroxychloroquine, hydroxyzine, desloratadine, and methylprednisolone, which resulted in rapid control of clinical findings.

The authors noted their two case studies were unusual, in that patients with COVID-19 who receive immunotherapy tend to develop critical symptoms. However, the authors noted, their two patients did not present with major respiratory symptoms, but rather atypical and severe dermatologic findings.

Disclosure: For full disclosure of the study authors, visit sciencedirect.com.



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