Vincent Sibaud

Background: The expanding use of biologic and oral targeted therapies has transformed the management of psoriasis and atopic dermatitis. These agents are increasingly prescribed to patients with current malignancy, a history of malignancy or an increased cancer risk, populations typically excluded from clinical trials. In the absence of robust long‐term safety data, clinicians often rely on real‐world evidence to inform treatment decisions. Objectives: To review the evidence regarding malignancy risk associated with biologic and oral targeted therapies used in psoriasis and atopic dermatitis and to provide expert consensus recommendations for patients with current malignancy, previous malignancy or increased risk of malignancy. Methods: We describe the physiological roles of key immune pathways targeted in psoriasis and atopic dermatitis, as well as in cancer immunosurveillance, tumour progression and immune escape. We then summarize evidence from randomized controlled trials regarding the risk of de novo malignancy, followed by a synthesis of real‐world data addressing cancer recurrence and progression in patients treated with biologic and oral targeted therapies. Results: Available evidence suggests that the overall malignancy risk associated with most biologic and oral targeted therapies used in psoriasis and atopic dermatitis is low, although differences between therapeutic classes may exist. Real‐world data remain limited for several therapeutic classes and in patients with active or previous malignancy. Conclusions: Based on the available evidence, we present consensus‐based recommendations developed by a multidisciplinary expert panel convened by the Skin Inflammation & Psoriasis International Network–Fondation René Touraine (SPIN‐FRT). These recommendations aim to support treatment decisions by balancing disease control with potential cancer‐related risks while highlighting key evidence gaps.

Background: With the widespread use of immune checkpoint inhibitors (ICI), rare cutaneous immune‐related adverse events (cirAEs), including ICI‐induced eosinophilic fasciitis (ICI‐EF), are increasingly encountered. However, data on its clinical presentation and optimal therapeutic approaches remain sparse. Objectives: This study aimed to further characterize the clinical features and outcomes of ICI‐EF. Methods: This retrospective observational study analysed clinical features, treatment strategies and outcomes of ICI‐EF cases from EADV Task Force‐affiliated dermatology departments, complemented by cases from the current available literature and two international pharmacovigilance databases. Patient demographics, clinical characteristics, diagnostics, treatment and follow‐up data were extracted from the medical records and databases. Results: We present 121 ICI‐EF cases from the EADV Task Force ( n = 15), FPVD ( n = 21), VigiBase® ( n = 45) and the literature ( n = 40). The most prevalent underlying malignancy in all groups was melanoma (50%), with PD‐1 inhibitor monotherapy (81%) being the predominant offending drug class. The median time to ICI‐EF onset was 10 months (IQR 6.8–16.3; range < 1–36). Detailed clinical information was available for 76 of the 121 cases (63%), revealing a highly variable clinical presentation. Treatment primarily involved ICI discontinuation (83%) and systemic corticosteroids (80%), followed by methotrexate (41%), intravenous immunoglobulins (12%) and mycophenolate mofetil (13%), resulting in the partial or complete resolution of ICI‐EF symptoms (66%). Conclusions: ICI‐EF is a rare heterogeneous cirAE with varying clinical features and significant morbidity. Early recognition and timely treatment are key to ensuring ICI continuation and preserve oncologic outcomes.

The phase 1b TICIMEL clinical trial evaluated the safety, tolerability, and anti-tumor activity of combining the immune checkpoint inhibitors (ICI), ipilimumab and nivolumab, with tumor necrosis factor (TNF) blockers, certolizumab or infliximab, to treat advanced melanoma patients. A higher proportion of responses was observed in patients receiving ICI and certolizumab, while patients treated with ICI and infliximab demonstrated superior tolerability. Moreover, CITE-Seq analyses of circulating CD8 T cells showed that ICI plus certolizumab promoted an IFN signature, whereas ICI plus infliximab reduced the induction of genes associated with T cell activation. In preclinical models, ICI and TNF blockade with certolizumab increased IFN-γ ⁺ CD8 T cells and reduced regulatory T cells in tumors. The IgG1 Fc fragment of infliximab was identified as counteracting the benefits of TNF blockade. These findings underscore the importance of selecting the optimal TNF blocker to combine with ICI to enhance therapy efficacy in melanoma patients. ClinicalTrials.gov identifiers: NCT03293784 ; NCT05867004 .

Cancer immunotherapy, particularly immune checkpoint inhibitors (ICI), has revolutionized oncology treatment by leveraging the immune system to recognize and eliminate cancer cells. However, despite its efficacy, immunotherapy may induce immune‐related adverse events (irAEs), including dermatological events, that can range from mild rashes to severe life‐threatening conditions such as toxic epidermal necrolysis. This paper aims to explore and analyse the preventive measures for cutaneous irAEs (cirAEs). By identifying risk factors, recognizing early signs and implementing preventive strategies, healthcare professionals can significantly mitigate the severity of irAEs, thereby improving patient outcomes and quality of life.