Immune-related lichenoid mucocutaneous erosions during anti-PD-1 immunotherapy in metastatic renal cell carcinoma - A case report

Nivolumab belongs to the standard treatment options in metastatic renal cell carcinoma. Despite promising responses, a new spectrum of “immune-related” adverse effects has to be managed in daily clinical practice. A 74-year-old patient was treated with nivolumab in fourth-line. After 18 cycles, treatment was stopped due to severe adverse mucocutaneous reactions confirming a lichen ruber pemphigoides. CT scans during treatment discontinuation show stable disease since more than 14 months. Immunotherapy can cause mucocutaneous immune-mediated adverse reactions. The time of onset to cutaneous adverse effects is variable. Early recognition and treatment are essential in mitigating the severity of those adverse events. Keywords: Renal cell cancer, Nivolumab, Lichen ruber, Side effects, Cutaneous adverse event