Lichenoid mucocutaneous reactions associated with sintilimab therapy in a non-small cell lung adenocarcinoma patient: case report and review

Shuting Zhou; Zhenyu Zhang; Xiaodong Feng; Chengjian Zhao; Lu Jiang

doi:10.3389/fphar.2023.1276788

Lichenoid mucocutaneous reactions associated with sintilimab therapy in a non-small cell lung adenocarcinoma patient: case report and review

Front Pharmacol. 2023 Dec 12:14:1276788. doi: 10.3389/fphar.2023.1276788. eCollection 2023.

Authors

Shuting Zhou¹, Zhenyu Zhang¹, Xiaodong Feng¹, Chengjian Zhao², Lu Jiang¹

Affiliations

¹ State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
² State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, Sichuan, China.

Abstract

The immune checkpoint inhibitor (ICI), anti-programmed cell death receptor-1 (PD-1) antibody, has gained widespread approval for treating various malignancies. Among the immune-related adverse reactions (irAEs) during ICI treatment, the lichenoid reaction is noteworthy. Sintilimab, a new PD-1 inhibitor, has secured approval in China for treating refractory non-Hodgkin's lymphoma, and phase I/II clinical trials for other solid tumors are ongoing both domestically and abroad. This paper presents a case of a mucocutaneous lichenoid reaction associated with sintilimab therapy, its diagnosis, and management. Our study, using multiplex immunofluorescence staining, reveals localized infiltration of CD4⁺ and CD8⁺ T lymphocytes in the subepithelial lamina propria region with upregulated PD-1 expression, implying an association between PD-1 expression upregulation and lichenoid reactions provoked by PD-1 monoclonal antibody. We provide a summary of clinical characteristics and treatment guidelines for lichenoid reactions induced by ICIs from previous reports, highlighting the success of a combined therapeutic regimen of oral antihistamines and topical corticosteroids in controlling symptoms without interrupting ICI treatment.

Keywords: PD-1 inhibitor; Sintilimab Therapy; immune checkpoint inhibitors (ICIs); immune-related adverse events (irAEs); lichenoid reactions; mucocutaneous reactions; non-small cell lung adenocarcinoma.

Publication types

Case Reports

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by National Natural Science Foundation of China (82171809), Clinical and Translational Medicine Research Foundation of Chinese Academy of Medical Sciences (2022-I2M-C&T-B-111), and Research and Develop Program, West China Hospital of Stomatology Sichuan University (RD-03-202307).