Review Article

Advanced Care Provider and Nursing Approach to Assessment and Management of Immunotherapy-Related Dermatologic Adverse Events

Kathryn Ciccolini,(1) BSN, RN, OCN®, DNC, Anna Skripnik Lucas,(1) MSN, RN, DNC, FNP-BC, Alyona Weinstein,(2) MSN, FNP-BC, and Mario Lacouture,(1) MD

(1)Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; (2)Melanoma and Immunotherapeutics Service, Memorial Sloan Kettering Cancer Center, New York, New York

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Kathryn Ciccolini, BSN, RN, OCN®, DNC, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022. E-mail: ciccolik@mskcc.org

ABSTRACT

Abstract

Advanced care providers (ACPs) and nurses are fundamental players in the assessment and management of immunotherapy-related dermatologic adverse events (irdAE). Pembrolizumab, nivolumab, and ipilimumab are approved for unresectable or metastatic melanoma, metastatic non–small cell lung cancer (pembrolizumab and nivolumab), metastatic head and neck squamous cell carcinoma (pembrolizumab and nivolumab), advanced renal cell carcinoma, and Hodgkin lymphoma (nivolumab). Atezolizumab is approved for urothelial carcinoma. These agents function as immune checkpoint inhibitors, activating T-cell–mediated antitumor immune responses through the inhibition of the programmed cell death protein 1 (PD-1) or cytotoxic T-lymphocyte antigen 4 (CTLA-4). Immune checkpoint inhibitors have been reported to cause irdAEs, including rash, pruritus, and vitiligo, requiring an interdisciplinary approach to avoid dose reduction or discontinuation of treatment and to maintain quality of life. Advanced care providers and nurses play a critical role in the attribution, grading, and management of these untoward events and must be knowledgeable about their pathophysiology, incidence, assessment, and clinical presentation.

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