Case Report and Literature Review on Skin Toxicity Induced by PD-1 Inhibitor in a Penile Cancer with Massive Ulceration of Chemoradiotherapy-Resistant and Successful Treatment by Immunotherapy

Yanyan Zhu,1 Daxia Cai,2 Jiangle Jiang,3 Jianfei Tu,2 Zhifeng Tian,4 Xiayan Zhang,1 Songmei Luo,1 Yonghui Wang2 1Department of Pharmacy, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, People’s Republic of China; 2Thoracic Oncology Center, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, People’s Republic of China; 3Department of Pathology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, People’s Republic of China; 4Head and Neck Oncology Center, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, People’s Republic of ChinaCorrespondence: Yonghui Wang, Thoracic Oncology Center, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, People’s Republic of China, Tel +86-10-0578-2285348, Email [email protected]: Penile cancer is a rare malignant tumor with a poor prognosis in advanced stages. Immune checkpoint inhibitors (ICIs) have demonstrated promising efficacy in patients with advanced penile cancer, but it can also induce immune-related adverse events (irAEs). This article reports a patient who achieved almost a complete response to the PD-1 inhibitor sintilimab as third-line treatment for advanced penile squamous cell cancer with massive ulceration of chemoradiotherapy-resistant, and successful treatment by immunotherapy. One year into maintenance therapy with sintilimab, skin toxicity in the form or grade-2 skin rashes and grade-3 pruritus occurred. Sintilimab was permanently discontinued. The skin toxicity was effectively controlled by oral prednisone at a daily dosage of 15 mg. At the last follow-up of 16 months after sintilimab discontinuation, the patient remained in partial response, with total progression-free survival exceeding 30 months. We also conducted a comprehensive literature search, and summarized skin toxicity of ICIs administration. These articles suggested that immune-related skin toxicity may be indicative of good treatment response.Keywords: penile cancer, immune checkpoint inhibitors, sintilimab, skin toxicity, immunotherapy, case report