Dr Rohs on Pityriasis Rubra Pilaris as an Early Signal of Lung Cancer Recurrence

Nicholas C. Rohs, MD, assistant professor, medicine, hematology, and medical oncology, Mount Sinai, discusses a case study that he presented during the Interesting Cases session at the 18th Annual New York Lung Cancers Symposium^®.

Case studies are important to present because some cases pose treatment challenges that oncology colleagues can discuss with each other to parse through the nuances of individual patients, Rohs says. At the meeting, Rohs presented a case study of a patient who presented with an uncommon form of lung cancer relapse. This patient originally presented with early-stage adenocarcinoma, which had high immune expression and some unimpactful genetic changes, Rohs explains. This patient initially received surgery with curative intent, Rohs notes.

However, this patient subsequently developed a skin rash known as pityriasis rubra pilaris, which many thoracic oncologists are unfamiliar with, according to Rohs. The patient’s dermatologist identified the atypical rash and referred her back to thoracic oncology. Previous case reports have indicated that pityriasis rubra pilaris is related to lung cancer, and a positron emission tomography scan confirmed that this rash was an early sign of her cancer recurring, Rohs says.

This patient had a history of psoriasis and eczema, which necessitated the treatment of this rash, Rohs notes. Rohs decided to treat this patient with immunotherapy because of her tumor’s high immune expression, while paying close attention to the development of immune-related adverse effects (irAEs). However, this patient developed irAEs, and Rohs wondered whether they were related to the dermatology drugs she was receiving. This case is an example of the nuanced challenges that arise when trying to deliver optimal care to individual patients, Rohs emphasizes. Since the patient was responding to immunotherapy, Rohs deliberated between continuing the immunotherapy, prioritizing treating the irAEs, or attempting to do both.

Decisions surrounding the intersections between oncology drugs and other drugs patients may receive, as well as the decision to implement steroids, are unique challenges that arise in clinical practice, Rohs says. Sharing case studies such as this one and discussing treatment approaches is crucial, Rohs concludes.