PD-1/PD-L1 inhibitors are novel anti-cancer agents for various tumors. PD-1/PD-L1 inhibitors induced rash occurred in 20% to 30%. The therapy for rash includes anti-histamine and corticosteroid. Bilastine is a non-sedating second-generation H1-antihistamine. Bilastine showed the efficacy for urticaria, prurigo and cutaneous pruritus. However, its effectiveness for PD-1/PD-L1 inhibitors induced rash is unknown. The objective of this retrospective study was to evaluate the efficacy of bilastine for PD-1/PD-L1 inhibitors induced rash.
We identified 224 patients who received PD-1/PD-L1 inhibitors (nivolumab, pembrolizumab, atezolizumab) at the Kure Medical Center from September 2014 to October 2018. PD-1/PD-L1 inhibitors induced rashes were observed in 84 patients (37.5%). They were classified into 4 groups on the basis of the systemic antihistamine and topical corticosteroid therapy: the (1) bilastine and corticosteroid group (n = 18), (2) another anti-histamine and corticosteroid group (n = 22), (3) bilastine group (n = 20); and (4) another antihistamine group (n = 24). Adverse events were graded according to the Common Terminology Criteria for Adverse Events (version 4.0). This study was approved by the Kure Medical Center IRB.
The bilastine and corticoegsteroid group had significantly shorter the median duration of topical corticosteroids and antihistamine than the another antihistamine and corticosteroid group (p<0.01). Bilastine group had significantly shorter the period of systemic medications than the another antihistamine group (p<0.01). The incidence of adverse events was observed as follows, somnolence in 3% (1/38), headache 3% (1/38) and dizziness in 3% (1/38) in the bilastine and corticosteroid group and bilastine group. There were no serious adverse events.
Bilastine treatment reduced the need for topical corticosteroids use and shortened the period of topical corticosteroids for PD-1/PD-L1 inhibitors induced rash with acceptable safety profiles. Bilastine may be more effective than another antihistamine for PD-1/PD-L1 inhibitors induced rash.
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The author has declared no conflicts of interest.