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- Presentation
Novel Therapeutics for Cancer Treatment-Related Skin Toxicities
Description
The talk reviewed novel dermatologic treatments for cancer therapy–related skin toxicities, focusing on JAK inhibitors for steroid-refractory cutaneous immune-related adverse events from checkpoint inhibitors and management of skin toxicity from RAS inhibitors. A case of a man with metastatic lung cancer and severe pembrolizumab-associated pruritic dermatitis illustrated the challenge of treating persistent eruptions in patients with active malignancy. A retrospective survey of 14 cases found that systemic JAK inhibitors helped most patients with eczema, psoriasis, alopecia areata, vitiligo, or TEN after failure of topical and/or systemic steroids and other therapies; responses were generally rapid for eczema and psoriasis, slower for hair and pigment disorders, and the drugs were well tolerated with no venous thromboembolism or major cardiovascular events reported. Cancer outcomes were mostly reassuring, with no progression in most patients who had active cancer at JAK initiation, though the study was small and subject to bias. The second case described a patient with metastatic pancreatic cancer on the pan-RAS inhibitor daraxonrasib who developed severe acneiform eruption, erosive dermatitis, cheilitis, hand fissuring, and low zinc, forcing treatment interruption and raising concern for cancer progression. The speaker emphasized that RAS inhibitors can cause EGFR-like toxicities, especially acneiform rash and zinc deficiency, and recommended prophylaxis with tetracyclines, topical steroids, emollients, and sun protection for higher-risk agents, along with checking and correcting serum zinc—particularly when erosive or ulcerative dermatitis is present.
View moreConclusions
- JAK inhibitors appear to be a useful option for steroid-refractory cutaneous immune-related adverse events from checkpoint inhibitors, with most reported patients improving.
- In the presented cohort, JAK inhibitor use did not obviously cause frequent cancer acceleration, since only 2 of 14 patients had tumor progression while receiving treatment.
- The available evidence is still limited by small sample size, retrospective design, and reporting bias, so stronger prospective data are needed before firm conclusions can be made.
- Cutaneous toxicities from pan-RAS inhibitors can be substantial and often resemble EGFR-inhibitor eruptions, especially acneiform rash, erosive dermatitis, cheilitis, and hand fissuring.
- Managing RAS-inhibitor skin toxicity with EGFR-style prophylaxis or treatment, including tetracyclines, topical steroids, emollients, and sun protection, is a reasonable approach.
- Hypozincemia appears to be an important contributor to erosive dermatitis in patients on RAS inhibitors, so serum zinc should be checked and replaced when low.
- Selective RAS inhibitors usually need reactive management rather than routine prophylaxis, while pan-RAS inhibitors may warrant upfront preventive care.
- Overall, the presentation supports JAK inhibitors as a promising dermatologic strategy in oncology patients and emphasizes proactive toxicity management to preserve cancer therapy when possible.
- Liu et al. – 89% response rate
- Habib et al. – 71% response rate
- JAK inhibition enhances checkpoint blockade immunotherapy in patients with Hodgkin lymphoma#10.1126/science.ade8520
- Combined JAK inhibition and PD-1 immunotherapy for non-small cell lung cancer patients#10.1186/isrctn49817477