- Email: [email protected]
Dermatologic adverse events during treatment with anti-PD1 inhibitors
2804
3749
Cutaneous lymphoma in Korea: A nationwide retrospective study Hyun Soo Lee, MD, Ajou University School of Medicine, Suwon, South Korea; Ji Young Yang, MD, Ajou University School of Medicine, Suwon, South Korea; Kee Suck Suh, MD, PhD, Kosin University College of Medicine, Busan, South Korea; Dong-Youn Lee, MD, PhD, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea; Kwang Hyun Cho, MD, PhD, Seoul National University College of Medicine, Seoul, South Korea; Soo-Chan Kim, MD, PhD, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Seok-Jong Lee, MD, PhD, Kyungpook National University School of Medicine, Daegu, South Korea; Tae Young Yoon, MD, PhD, Chungbuk National University School of Medicine, Cheongju, South Korea; Young Ho Won, MD, PhD, Chonnam National University Medical School, Gwangju, South Korea; You Chan Kim, MD, PhD, Ajou University School of Medicine, Suwon, South Korea The epidemiologic and clinicopathologic features of cutaneous lymphoma (CL) may vary according to geographic area. Until now, a few large-scale epidemiological studies of CL have been performed mainly in the USA and Europe. The aim of this study is to demonstrate the recent epidemiology and clinicopathologic characteristics of CL in Korea according to the WHO and the EORTC classification. The patients newly diagnosed as CL from January 2009 to December 2013 at 32 tertiary institutes were enrolled and retrospectively reviewed. Total 422 cases had been diagnosed as CL, with 333 cases of primary CL and 89 cases of secondary CL. Among primary CL, 293 cases (88%) were mature T-cell and natural killer (NK)-cell lymphoma, and mycosis fungoides was the most prevalent subtype. Diffuse large B-cell lymphoma (DLBCL) was most common among 39 cases (11.7%) of mature Bcell lymphoma. The incidence of mature B-cell lymphoma in Korea was lower than in Europe and USA. DLBCL was more prevalent subtype of mature B-cell lymphoma in Korea than in Western countries. In addition, the incidence of extranodal NK/Tcell lymphoma, nasal type was higher than in Western countries, and even Japan, although it has been decreased during recent 10 years.
Dermatology interconsultations in a hospital setting for a 3-year period of time Sonia Chavez-Alvarez, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez,’’ Monterrey, Mexico; Ana Sofia Ayala-Cortes, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez,’’ Monterrey, Mexico; Minerva Flores-Gomez, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez,’’ Mexico; Maira Herz-Ruelas, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez,’’ Monterrey, Mexico; Jorge Ocampo-Candiani, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez,’’ Monterrey, Mexico
Commercial support: None identified.
Introduction: Patients are admitted to the hospital due to diverse conditions, most patients seen by our dermatology department are inpatients due to systemic disease and not due to dermatologic conditions. However there is limited literature reporting main dermatologic hospital consultations. We aim to determine the most frequent dermatologic conditions presenting in inpatients. Methods: This is a retrospective study from the period of March 2012 to March 2015 in the University Hospital ‘‘Dr Jose Eleuterio Gonzalez,’’ a public hospital in the northeast region of Mexico. All dermatologic consultations from the ER and other hospital departments (surgery, internal medicine, gynecology, and orthopedics) were collected from the dermatology consultations database a total of 1061. All of the consultations are evaluated within the first 24 hours upon request, and the patients were followed up in the hospital setting until resolution of the skin lesions, diagnosis establishment, or if needed, afterward in the outpatient dermatology clinic. Results: A total of 1061 consultations were required. There was a male predominance pattern with 601 vs 460 females. Diagnoses were confirmed with histopathologic study, Tzanck testing, KOH scrapings, or based on clinical grounds according to dermatosis. The most frequent consultations were drug eruptions with 132 patients: morbiliform exanthema 72%, erythema multiforme major and minor 17%, StevenseJohnson syndrome 6%, fixed drug eruption and drug reaction with eosinophilia and systemic symptoms 2.6% each, AGEP 1.4%, and toxic epidermal necrolysis 1%. The second place in number were the viral infections with 106 patients (herpes 60%, varicella zoster 9.4%, human papillomavirus 9.4% and poxvirus 20%). The third in frequency were superficial fungal infections with 85 patients: dermatophytosis 40.5%, tinea versicolor 28.2%, and Candida infections 12%. Internal medicine required 75% of consultations, followed by general surgery 5.8%; lower rates were attributed to other departments. Conclusion: Dermatologic inpatient consultations differ in number and condition upon the hospital level of care and country. Our study can provide a frame of reference for dermatologist and nondermatologist practitioners in this area, to reinforce the knowledge and expertise in those entities. It is fundamental to know what we are most likely to encounter in a clinical setting, in order to give the best medical care. Commercial support: None identified.
3024
3065 Dermatologic adverse events during treatment with anti-PD1 inhibitors Benjamin Benhuri, Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; V. R. Belum, MD, Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Mario Lacouture, MD, Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, United States Background: Nivolumab and pembrolizumab are next generation immune checkpoint inhibitors of the PD-1 receptor, currently approved in the treatment of advanced melanoma; nivolumab is also approved for nonesmall cell lung cancer treatment. The common AEs include dermatologic AEs (eg, rash, pruritus, pigmentary disorders)—the former in particular can lead to alterations in dosing and impairment of health-related quality of life. Methods: We conducted a systematic review and metaanalysis of published clinical trials reporting dermatologic AEs, to determine the incidence and risk of developing these AEs in cancer patients treated with either nivolumab or pembrolizumab. PubMed, Web of Science, and the ASCO annual meeting abstracts’ library were searched. Phase I/ II/ III clinical trials that investigated nivolumab (2 mg/kg) and pembrolizumab (3 mg/kg) at FDA-approved doses were included. The incidence, relative risk (RR), and 95% CIs were calculated using either random- or fixed-effects models based on the heterogeneity of included trials. Results: 1095 patients treated with nivolumab were analyzed; the most common AEs included rash [incidence of all-grade rash, 14.3% (95% CI: 8.7-22.8%); high-grade, 1.2% (95% CI: 0.5-2.9%)], pruritus [incidence of all-grade pruritus, 13.2% (95% CI: 8.9-19.2%); high-grade, 0.5% (95% CI: 0.2-1.3%)], and pigmentary disorders [incidence of all-grade vitiligo, 7.5% (95% CI: 5.9-9.5%)]. Among patients treated with pembrolizumab (n ¼ 184), the overall incidences of all-grade rash and highgrade rash were 16.7% (95% CI: 11.9-23.0%) and 1.7% (95% CI: 0.4-6.7%), respectively. The other AEs included pruritus [incidence of all-grade pruritus, 20.2% (95% CI: 14.8-26.9 %); high-grade pruritus, 2.3% (95% CI: 0.7-7.6%), and vitiligo [incidence of all-grade vitiligo, 8.3% (95% CI: 4.4-15.2%)]. The relative risk of all-grade rash when compared to controls, was increased with both nivolumab (RR ¼ 2.5, 95% CI: 1.27-5.01, P \.008), and pembrolizumab (RR ¼ 2.64, 95% CI: 1.245.58, P \.011). The relative risk of all-grade pruritus was also increased with both nivolumab (RR ¼ 34.4, 95% CI: 2.16-550.68, P \.012), and pembrolizumab (RR ¼ 49.9, 95% CI: 3.1-806.0, P \.006).
Estimating the cost of Mohs micrographic surgery Emily Ruiz, MD, Brigham & Women’s Hospital, Jamaica Plain, MA, United States; Pritesh Karia, MPH, Brigham & Women’s Hospital, Jamaica Plain, Michigan; Juanita Duran, MD, Brigham & Women’s Hospital, Jamaica Plain, MA, United States; Christine Liang, MD, Brigham & Women’s Hospital, Jamaica Plain, MA, United States; Chrysalyne Schmults, MD, Brigham & Women’s Hospital, Jamaica Plain, MA, United States Importance: In recent years, more medical cost information has become available to medical consumers. However, it is unclear whether consumers and physicians have an understanding of the cost of performing medical procedures. Objective: To determine patients’ perception of the cost of Mohs micrographic surgery (MMS) and to compare these perceptions to the estimated cost of administering MMS. Design: A six month cost survey of consecutive MMS patients. Setting: Academic dermatologic surgery center. Participants: A cost survey was distributed to consecutive MMS patients at their first visit postsurgery. The cost of performing a MMS case was calculated for four U.S. geographic regions based on average cost of office space in that region, staff salaries, and cost of supplies. The annual total cost was divided by number of MMS cases for average cost per case.
Conclusion: The most common AEs with both drugs include rash, pruritus, and vitiligo. However, the RR of developing pruritus is especially high. Appropriate prophylactic, treatment, and counseling strategies are needed to improve treatment outcomes.
Main outcomes and measures: Patients’ perception of the cost of MMS, a fair price for insurers to pay for MMS, and a fair out-of-pocket price for MMS. Results: A total of 125 patients completed the cost survey. Of the respondents, 66%, 18%, and 16% estimated the cost of MMS to be $$2000, $1000-$2000, and #$1000, respectively. Similarly, 59%, 21%, and 20% of respondents designated $$2000, $1000-$2000, and #$1000, respectively, for a fair price for insurers to pay for MMS. However, when asked to estimate a fair out-of-pocket price for MMS, 30%, 24%, and 37% designated $$2000, $1000-$2000, and #$1000, respectively. This represents a 50% drop in patients willing to pay $$2000 for MMS. Responses did not differ by income level. The estimated cost of performing a MMS case ranged from $1662 to $2218, with variance primarily due to differing case volumes. Conclusions and relevance: There is discord between patients’ cost estimate of MMS and the amount they are willing to pay out-of-pocket. Given that the cost of MMS varies by case volume, it may be difficult for patients to accurately assess the cost of MMS. As patients contribute more out-of-pocket, it is important to better understand both the cost to deliver care as well as the amount patients are willing to spend. Further studies assessing both variables will improve access to care and patient satisfaction.
Commercial support: None identified.
Commercial support: None identified.
AB116
J AM ACAD DERMATOL
MAY 2016
3749
Cutaneous lymphoma in Korea: A nationwide retrospective study Hyun Soo Lee, MD, Ajou University School of Medicine, Suwon, South Korea; Ji Young Yang, MD, Ajou University School of Medicine, Suwon, South Korea; Kee Suck Suh, MD, PhD, Kosin University College of Medicine, Busan, South Korea; Dong-Youn Lee, MD, PhD, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea; Kwang Hyun Cho, MD, PhD, Seoul National University College of Medicine, Seoul, South Korea; Soo-Chan Kim, MD, PhD, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Seok-Jong Lee, MD, PhD, Kyungpook National University School of Medicine, Daegu, South Korea; Tae Young Yoon, MD, PhD, Chungbuk National University School of Medicine, Cheongju, South Korea; Young Ho Won, MD, PhD, Chonnam National University Medical School, Gwangju, South Korea; You Chan Kim, MD, PhD, Ajou University School of Medicine, Suwon, South Korea The epidemiologic and clinicopathologic features of cutaneous lymphoma (CL) may vary according to geographic area. Until now, a few large-scale epidemiological studies of CL have been performed mainly in the USA and Europe. The aim of this study is to demonstrate the recent epidemiology and clinicopathologic characteristics of CL in Korea according to the WHO and the EORTC classification. The patients newly diagnosed as CL from January 2009 to December 2013 at 32 tertiary institutes were enrolled and retrospectively reviewed. Total 422 cases had been diagnosed as CL, with 333 cases of primary CL and 89 cases of secondary CL. Among primary CL, 293 cases (88%) were mature T-cell and natural killer (NK)-cell lymphoma, and mycosis fungoides was the most prevalent subtype. Diffuse large B-cell lymphoma (DLBCL) was most common among 39 cases (11.7%) of mature Bcell lymphoma. The incidence of mature B-cell lymphoma in Korea was lower than in Europe and USA. DLBCL was more prevalent subtype of mature B-cell lymphoma in Korea than in Western countries. In addition, the incidence of extranodal NK/Tcell lymphoma, nasal type was higher than in Western countries, and even Japan, although it has been decreased during recent 10 years.
Dermatology interconsultations in a hospital setting for a 3-year period of time Sonia Chavez-Alvarez, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez,’’ Monterrey, Mexico; Ana Sofia Ayala-Cortes, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez,’’ Monterrey, Mexico; Minerva Flores-Gomez, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez,’’ Mexico; Maira Herz-Ruelas, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez,’’ Monterrey, Mexico; Jorge Ocampo-Candiani, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez,’’ Monterrey, Mexico
Commercial support: None identified.
Introduction: Patients are admitted to the hospital due to diverse conditions, most patients seen by our dermatology department are inpatients due to systemic disease and not due to dermatologic conditions. However there is limited literature reporting main dermatologic hospital consultations. We aim to determine the most frequent dermatologic conditions presenting in inpatients. Methods: This is a retrospective study from the period of March 2012 to March 2015 in the University Hospital ‘‘Dr Jose Eleuterio Gonzalez,’’ a public hospital in the northeast region of Mexico. All dermatologic consultations from the ER and other hospital departments (surgery, internal medicine, gynecology, and orthopedics) were collected from the dermatology consultations database a total of 1061. All of the consultations are evaluated within the first 24 hours upon request, and the patients were followed up in the hospital setting until resolution of the skin lesions, diagnosis establishment, or if needed, afterward in the outpatient dermatology clinic. Results: A total of 1061 consultations were required. There was a male predominance pattern with 601 vs 460 females. Diagnoses were confirmed with histopathologic study, Tzanck testing, KOH scrapings, or based on clinical grounds according to dermatosis. The most frequent consultations were drug eruptions with 132 patients: morbiliform exanthema 72%, erythema multiforme major and minor 17%, StevenseJohnson syndrome 6%, fixed drug eruption and drug reaction with eosinophilia and systemic symptoms 2.6% each, AGEP 1.4%, and toxic epidermal necrolysis 1%. The second place in number were the viral infections with 106 patients (herpes 60%, varicella zoster 9.4%, human papillomavirus 9.4% and poxvirus 20%). The third in frequency were superficial fungal infections with 85 patients: dermatophytosis 40.5%, tinea versicolor 28.2%, and Candida infections 12%. Internal medicine required 75% of consultations, followed by general surgery 5.8%; lower rates were attributed to other departments. Conclusion: Dermatologic inpatient consultations differ in number and condition upon the hospital level of care and country. Our study can provide a frame of reference for dermatologist and nondermatologist practitioners in this area, to reinforce the knowledge and expertise in those entities. It is fundamental to know what we are most likely to encounter in a clinical setting, in order to give the best medical care. Commercial support: None identified.
3024
3065 Dermatologic adverse events during treatment with anti-PD1 inhibitors Benjamin Benhuri, Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; V. R. Belum, MD, Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Mario Lacouture, MD, Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, United States Background: Nivolumab and pembrolizumab are next generation immune checkpoint inhibitors of the PD-1 receptor, currently approved in the treatment of advanced melanoma; nivolumab is also approved for nonesmall cell lung cancer treatment. The common AEs include dermatologic AEs (eg, rash, pruritus, pigmentary disorders)—the former in particular can lead to alterations in dosing and impairment of health-related quality of life. Methods: We conducted a systematic review and metaanalysis of published clinical trials reporting dermatologic AEs, to determine the incidence and risk of developing these AEs in cancer patients treated with either nivolumab or pembrolizumab. PubMed, Web of Science, and the ASCO annual meeting abstracts’ library were searched. Phase I/ II/ III clinical trials that investigated nivolumab (2 mg/kg) and pembrolizumab (3 mg/kg) at FDA-approved doses were included. The incidence, relative risk (RR), and 95% CIs were calculated using either random- or fixed-effects models based on the heterogeneity of included trials. Results: 1095 patients treated with nivolumab were analyzed; the most common AEs included rash [incidence of all-grade rash, 14.3% (95% CI: 8.7-22.8%); high-grade, 1.2% (95% CI: 0.5-2.9%)], pruritus [incidence of all-grade pruritus, 13.2% (95% CI: 8.9-19.2%); high-grade, 0.5% (95% CI: 0.2-1.3%)], and pigmentary disorders [incidence of all-grade vitiligo, 7.5% (95% CI: 5.9-9.5%)]. Among patients treated with pembrolizumab (n ¼ 184), the overall incidences of all-grade rash and highgrade rash were 16.7% (95% CI: 11.9-23.0%) and 1.7% (95% CI: 0.4-6.7%), respectively. The other AEs included pruritus [incidence of all-grade pruritus, 20.2% (95% CI: 14.8-26.9 %); high-grade pruritus, 2.3% (95% CI: 0.7-7.6%), and vitiligo [incidence of all-grade vitiligo, 8.3% (95% CI: 4.4-15.2%)]. The relative risk of all-grade rash when compared to controls, was increased with both nivolumab (RR ¼ 2.5, 95% CI: 1.27-5.01, P \.008), and pembrolizumab (RR ¼ 2.64, 95% CI: 1.245.58, P \.011). The relative risk of all-grade pruritus was also increased with both nivolumab (RR ¼ 34.4, 95% CI: 2.16-550.68, P \.012), and pembrolizumab (RR ¼ 49.9, 95% CI: 3.1-806.0, P \.006).
Estimating the cost of Mohs micrographic surgery Emily Ruiz, MD, Brigham & Women’s Hospital, Jamaica Plain, MA, United States; Pritesh Karia, MPH, Brigham & Women’s Hospital, Jamaica Plain, Michigan; Juanita Duran, MD, Brigham & Women’s Hospital, Jamaica Plain, MA, United States; Christine Liang, MD, Brigham & Women’s Hospital, Jamaica Plain, MA, United States; Chrysalyne Schmults, MD, Brigham & Women’s Hospital, Jamaica Plain, MA, United States Importance: In recent years, more medical cost information has become available to medical consumers. However, it is unclear whether consumers and physicians have an understanding of the cost of performing medical procedures. Objective: To determine patients’ perception of the cost of Mohs micrographic surgery (MMS) and to compare these perceptions to the estimated cost of administering MMS. Design: A six month cost survey of consecutive MMS patients. Setting: Academic dermatologic surgery center. Participants: A cost survey was distributed to consecutive MMS patients at their first visit postsurgery. The cost of performing a MMS case was calculated for four U.S. geographic regions based on average cost of office space in that region, staff salaries, and cost of supplies. The annual total cost was divided by number of MMS cases for average cost per case.
Conclusion: The most common AEs with both drugs include rash, pruritus, and vitiligo. However, the RR of developing pruritus is especially high. Appropriate prophylactic, treatment, and counseling strategies are needed to improve treatment outcomes.
Main outcomes and measures: Patients’ perception of the cost of MMS, a fair price for insurers to pay for MMS, and a fair out-of-pocket price for MMS. Results: A total of 125 patients completed the cost survey. Of the respondents, 66%, 18%, and 16% estimated the cost of MMS to be $$2000, $1000-$2000, and #$1000, respectively. Similarly, 59%, 21%, and 20% of respondents designated $$2000, $1000-$2000, and #$1000, respectively, for a fair price for insurers to pay for MMS. However, when asked to estimate a fair out-of-pocket price for MMS, 30%, 24%, and 37% designated $$2000, $1000-$2000, and #$1000, respectively. This represents a 50% drop in patients willing to pay $$2000 for MMS. Responses did not differ by income level. The estimated cost of performing a MMS case ranged from $1662 to $2218, with variance primarily due to differing case volumes. Conclusions and relevance: There is discord between patients’ cost estimate of MMS and the amount they are willing to pay out-of-pocket. Given that the cost of MMS varies by case volume, it may be difficult for patients to accurately assess the cost of MMS. As patients contribute more out-of-pocket, it is important to better understand both the cost to deliver care as well as the amount patients are willing to spend. Further studies assessing both variables will improve access to care and patient satisfaction.
Commercial support: None identified.
Commercial support: None identified.
AB116
J AM ACAD DERMATOL
MAY 2016