Background Pruritus has been anecdotally described in association with targeted cancer therapies. The risk of pruritus has not been systematically ascertained. Objective A systematic review and meta-analysis of the literature was conducted for axitinib, cetuximab, dasatinib, erlotinib, everolimus, gefitinib, imatinib, ipilimumab, lapatinib, nilotinib, panitumumab, pazopanib, rituximab, sorafenib, temsirolimus, tositumomab, vandetanib, and vemurafenib. Methods Databases from PubMed, Web of Science (01/1998–07/2012), and American Society of Clinical Oncology abstracts (2004–2012) were searched. Incidence and risk (RR) of pruritus were calculated using random or fixed effects model. Results The incidences of all-grade and high-grade pruritus were 17.4% (95% confidence interval (CI): 16.0%−19.0%) and 1.4% (95% CI: 1.2%−1.6%), respectively. There was an increased risk of all-grade pruritus (RR=2.90 (95% CI: 1.76–4.77, p<0.001)); and variation among different drugs (P<0.001). Limitations The reporting of pruritus may vary, resulting from concomitant medications, comorbidities, and underlying malignancies. We found a higher incidence of pruritus in patients with solid tumors, concordant with those targeted therapies with the highest pruritus incidences. Conclusion There is a significant risk of developing pruritus in patients receiving targeted therapies. In order to prevent suboptimal dosing and decreased quality of life, patients should be counseled and treated against this untoward symptom.

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In the past decade, the expanded use of targeted anticancer drugs has significantly prolonged survival in patients treated for a variety of cancers. Despite their increased specificity, agents such as epidermal growth factor receptor inhibitors (EGFRIs), BRAF inhibitors, and targeted immunotherapies have commonly been associated with a number of dermatologic adverse events, often necessitating treatment modifications and negatively impacting patients' quality of life. Although toxicities such as rash and xerosis are frequently discussed, symptomatic pruritus, or itch, has emerged as an important, and frequently neglected, event. The present study reviews the incidence and clinical presentation of pruritus with the EFGRIs, and with two novel anti-melanoma drugs, vemurafenib and ipilimumab, with a focus on the putative underlying pathophysiology, and current management strategies.

Because the diagnosis dictates treatment, it is incumbent to establish a diagnosis as definitive as possible, obtaining second or third opinions and using ancillary studies when appropriate. When the diagnosis remains uncertain, it is difficult to provide guidelines for treatment. Clinical care decisions for patients with an uncertain diagnosis are best done on a case-by-case basis weighing probabilities of adverse outcomes against potential benefits and risks from various treatment options.

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