December 2021: Check Out Checkpoint Inhibitors

​"Hey, can you check out this rash? It is all over," a nurse said to me."What can you tell me?""He has metastatic cancer. The rash started a couple days ago.""It's probably a checkpoint inhibitor rash. I'll check it out."Medicine has developed an entirely new approach to cancer since I went to medical school. Therapeutics were all about direct toxicity to rapidly dividing cells a few decades ago. Now we have an entirely new classification of treatment: immunotherapy.Immunotherapy tries to increase the body's ability to use its own defenses against cancer. One group of agents is called checkpoint inhibitors, and these drugs aim to modulate the biological processes, allowing for increased ability to fight cancer. Checkpoint inhibitors essentially remove the brakes on the body's immune cells.This is complex. The number of drugs are always increasing, and it is difficult to remember the names and seems impossible to remember the different complications. The best I can say is to call the patient's oncologist when you see something weird in a patient on a checkpoint inhibitor; they more well versed in this. These drugs have a multitude of side effects, and dermatologic problems are common, perhaps affecting about half of patients.A call to the oncologist, along with the picture, confirmed this was a checkpoint inhibitor rash. Steroids and antihistamines were ordered. Of course, the checkpoint inhibitor therapy was stopped. The rash was ...
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