Analysis Shows High Incidence of Skin Eruptions with Tebentafusp in Uveal Melanoma

Tebentafusp-associated skin toxicity was prevalent in patients treated for metastatic uveal melanoma, a recent study reported.

Study researchers looked at a cohort study of 33 patients treated with tebentafusp and identified skin symptoms in 26 patients (median follow-up of 21.5 months for those experiencing skin toxicity). The data set included 68 acute skin eruptions, mostly affecting the face (69.1%) and torso (67.6%).

Overall, 83.8% of cases were primarily symmetrical erythematous patch eruptions, frequently accompanied by periorbital edema. Urticarial lesions were less frequent (7.4% of cases). Bullous detachment of the skin was lower (1.5%).

Upon histopathologic examination of skin biopsies, researchers found perivascular lymphocytic infiltration and a focal lymphocytic interface dermatitis, often accompanied by eosinophils or neutrophils. The authors also reported a reduction or absence of melanocytes in some cases, suggesting cytotoxic lymphocytes may target melanocytes during tebentafusp treatment.

There was a predilection for skin eruptions in sun-exposed areas, possibly linked to UVB-induced melanocyte activation, according to the study. Although skin eruptions often resolved without sequelae, the researchers noted that pigmentary changes were persistent.

"To date, tebentafusp is approved for the treatment of uveal melanoma which represents a rare tumor," the authors wrote in the study. "It is currently being investigated for advanced cutaneous melanoma and might be applied more frequently in the future, therefore knowledge and understanding of the pathogenesis of the tebentafusp associated rash will be crucial for the treating oncologists and dermatologists."

Source: Tomsitz D, et al. Journal of the American Academy of Dermatology. 2024. Doi:10.1016/j.jaad.2024.08.037