IMMUNE checkpoint inhibitors (ICIs) have transformed cancer care but can trigger immune-related adverse events such as psoriasis, complicating treatment decisions. A new international consensus offers guidance for managing these dermatologic effects without compromising cancer outcomes.
In the absence of high-level direct evidence, a multidisciplinary panel of 15 experts from dermatology, oncology, immunology, and rheumatology developed inference-based recommendations for systemic treatment of ICI-induced psoriasis (ICI-Ps). Using a structured Delphi process and a systematic review, the group evaluated systemic agents for psoriasis (saPs), including biologics targeting tumor necrosis factor and interleukins, traditional therapies like methotrexate and cyclosporine, oral small molecules, systemic retinoids, and corticosteroids.
The panel found that saPs can be used in patients with ICI-Ps without meaningfully reducing the effectiveness of ICIs. The conclusions were supported by indirect evidence and expert inference, emphasizing that interruption of ICI therapy is generally unnecessary. The guidance encourages the use of non-steroid systemic agents when available, due to the higher potential of corticosteroids to blunt immune response.
This new framework helps clinicians balance oncologic efficacy with the need to manage immune-related skin toxicity, especially in cases where psoriasis flares significantly impact quality of life. The findings may help clinicians initiate treatment for ICI-Ps with greater confidence and support informed discussions with patients receiving immunotherapy.
Although not based on direct trial evidence, the consensus provides structured, probability-based recommendations that aim to fill a critical gap in current practice. As ICIs continue to expand across tumor types, such pragmatic guidance is likely to be increasingly relevant.
Reference:
Papp KA et al. Systemic treatment of immune checkpoint inhibitor-induced psoriasis: Inference-based guidance. J Eur Acad Dermatol Venereol. 2025. doi: 10.1111/jdv.20809.
