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- Presentation
Itch and Cancer Therapeutics
Description
The presentation discusses the significant prevalence of pruritus in cancer patients, emphasizing its impact on quality of life. About 13% of cancer patients experience clinically significant itch, which may indicate malignancy and can arise from perineoplastic causes or cancer treatments. Conditions like Hodgkin's lymphoma and cutaneous T-cell lymphoma are highlighted for their strong association with chronic itch due to tumor-derived substances and immune responses. Treatments like EGFR inhibitors and immune checkpoint inhibitors have been noted for causing substantial itching. The presentation outlines a complex interplay of tumor-derived signals, immune cytokines, and neural changes contributing to pruritus, differentiating the management of itch due to cancer versus its treatments. Recommendations for treating itch include antihistamines, moisturizers, topical steroids, and systemic therapies like gabapentinoids and biologics, with dupilumab as a prominent recent option. Through case studies, the presenter underscores the importance of a tailored, multimodal therapeutic approach, aiming for minimal disruption of cancer treatment while effectively managing pruritus. Collaborative care amongst various specialties is encouraged to address the multifaceted nature of the condition.
View moreConclusions
- Pruritus affects approximately 13% of patients with cancer, presenting a significant clinical concern.
- There is a nearly six-fold increased risk of malignancy among patients experiencing pruritus.
- Pruritus in cancer patients can be classified as either perineoplastic or treatment-induced.
- Hematologic malignancies, particularly Hodgkin's lymphoma, have a high prevalence of pruritus, with over 30% of patients affected.
- Cancer treatments, including EGFR inhibitors and immune checkpoint inhibitors, can cause pruritus in a large proportion of treated patients.
- There are complex mechanisms behind cancer-related pruritus, including abnormal cytokine release, immune mediators, and peripheral nerve activation.
- Histamine-independent pathways are predominant in cancer-related pruritus, meaning traditional antihistamines are often ineffective.
- Management strategies for pruritus caused by cancer vary based on the underlying cause and severity of symptoms.
- There is an association between the development of cutaneous immune-related adverse events (cirAEs) from immunotherapy and improved overall survival in cancer patients.
- Using targeted biologic therapies for pruritus management is becoming more common and shows promise in improving patient outcomes.
- Larson V. et al., JAAD, 2019, Apr;80(4):931-937.
- Gobbi, P.G. et al., Cancer, 1983, 51: 1934-1936.
- Nattkemper L.A. et al., Skin. Acta Derm Venereol, 2016 Nov 2;96(7):894-898.
- Quach H.T. et al., JAAD, 2021 85(4):956-66.
- Lee J.S. et al., Acta Derm Venereol, 2024 Aug 28;104:adv40555.
- Di Salvo E. et al., Clin Mol Allergy. 2021 Jun 12;19(1):8.
- Allegra A. et al., Biomedicines, 2020 Dec 22;9(1):2.
- Bracci L., et al. Cell Death Differ, 2014 Jan;21(1):15-25.
- Lee, B. et al., Management of Melanoma; 2017; 15-23.
- Wu J. et al., Dermatol Clin. 2018 Jul;36(3):315-324.
- Zhang, S. et al., JAAD, 2023.