Clinical management of cutaneous adverse events in patients on targeted anticancer therapies and immunotherapies: a national consensus statement by the Spanish Academy of Dermatology and Venereology and the Spanish Society of Medical Oncology

Abstract

Progress in the understanding of many tumors has enabled the development of new therapies, such as those targeted at specific molecules involved in cell growth (targeted therapies) or intended to modulate the immune system (immunotherapy). However, along with the clinical benefit provided by these new treatments, new adverse effects have also appeared. Dermatological toxicities such as papulopustular eruptions, xerosis, and pruritus are common with EGFR inhibitors. Other adverse effects have also been described with PDGFR, BCR-ABL, and MAPK tyrosine kinase inhibitors, antiangiogenic drugs, and inhibitors at immune checkpoints such as CTLA-4 and PD-1/PD-L1. Onset of these adverse effects often causes dose reductions and/or delays in administering the prescribed therapy, which can affect patient survival and quality of life. It is, therefore, important to prevent the occurrence of these adverse effects, or to treat unavoidable ones as soon as possible. This requires cooperation between medical oncologists and dermatologists. This article reviews the various dermatological toxicities associated with targeted therapies and immunotherapies, along with their diagnosis and therapeutic management.

Cutaneous adverse events in patients receiving anticancer therapy in a tertiary hospital setting: the old and the new

“…In relation to pigmentary changes, hyperpigmentation usually occurs with conventional chemotherapy and hypopigmentation with targeted therapy, especially with immunotherapy 1,2 . In our study, pigmentary changes accounted for 7.3% of all CAEs (69% mild): 12 cases presented as hyperpigmentation associated with capecitabine, platinum agents, and taxanes, and one case of vitiligo associated with nivolumab (Fig.…”

“…Classic chemotherapy agents remain essential and are still frequently used in cancer treatment, and cutaneous adverse events (CAEs) related to use of these conventional drugs must be considered, such as palmar‐plantar erythrodysesthesia (PPE), alopecia, photosensitivity, or ungual apparatus lesions. Nevertheless, in recent years, advances in molecular biology and the increasing use of targeted therapy and immunotherapy have been associated with special CAEs and a greater interest in the prevention, diagnosis, and management of these cutaneous toxicities 1‐12 …”

Development and clinical applications of cancer immunotherapy against PD-1 signaling pathway

“…Rash and pruritus are among the most common AEs and usually require a set of general recommendations to keep skin AEs under control. These recommendations include wearing loose clothing, avoiding hot shower/baths, using unscented soaps, applying sunscreen when outside and moisturizing the skin regularly [80]. An itching management should be taught to patients so that a secondary infection does not arise from cuts on the skin.…”

Cutaneous adverse events and quality of life in outpatients receiving anticancer agents: results from an observational, cross-sectional study

“…Lee et al 33 also reported that patients on targeted therapy experienced worse QoL by means of DLQI. However, Unger et al 35 did not find differences in QoL between targeted therapy alone and combined targeted therapy and chemotherapy. These discrepancies may be due to differences in study designs and PRO instruments used to evaluate QoL, and highlights the interest in addressing this topic.…”