Oral aprepitant in the therapy of refractory pruritus in erythrodermic cutaneous T-cell lymphoma

Booken, Nina; Heck, Michael; Nicolay, Jan P.; Klemke, Claus‐Detlev; Goerdt, Sergij; Utikal, Jochen

doi:10.1111/j.1365-2133.2010.10108.x

Cited by 56 publications

(67 citation statements)

References 12 publications

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“…A recent study showed that aprepitant, a substance P receptor (NK1) antagonist, significantly inhibits scratching behavior in the NC/Nga mouse model of atopic dermatitis (101). More importantly, clinical studies demonstrated that aprepitant is effective for treating chronic pruritus, especially in patients with therapy-refractory pruritus (18, 128, 146). The inhibitory effect of this NK1 receptor antagonist could be caused by inhibition of substance P in the periphery or by blockage of NK1 + neurons in the dorsal spinal cord, which are involved in transmitting the itch sensation.…”

Section: Peripheral Itch Mediators and Related Receptorsmentioning

confidence: 99%

Itch Mechanisms and Circuits

Han

Dong²

2014

Annu. Rev. Biophys.

143

120

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The itch-scratch reflex serves as a protective mechanism in everyday life. However, chronic persistent itching can be devastating. Despite the clinical importance of the itch sensation, its mechanism remains elusive. In the past decade, substantial progress has been made to uncover the mystery of itching. Here, we review the molecules, cells, and circuits known to mediate the itch sensation, which, coupled with advances in understanding the pathophysiology of chronic itching conditions, will hopefully contribute to the development of new anti-itch therapies.

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Section: Peripheral Itch Mediators and Related Receptorsmentioning

confidence: 99%

Itch Mechanisms and Circuits

Han

Dong²

2014

Annu. Rev. Biophys.

143

120

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“…It has been used for itch in T-cell lymphoma, mycosis fungoides, solid tumors and itch related to biological cancer treatment (51)(52)(53)(54)(55) in an oral dose of 80-125 mg/day.…”

Section: Diagnostics and Treatmentmentioning

confidence: 99%

Paraneoplastic Itch: An Expert Position Statement from the Special Interest Group (SIG) of the International Forum on the Study of Itch (IFSI)

Weißhaar¹,

Weiß²,

Mettang³

et al. 2015

Acta Derm Venerol

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In clinical practice, the term "paraneoplastic itch" is used to describe itch in patients with cancer. Patients with hematological or solid tumor malignancies can be affected. In general, paraneoplastic itch is considered a rare disorder. However, paraneoplastic itch in hematological malignancies such as polycythemia vera and lymphoma are relatively frequent while other forms of paraneoplastic itch are in fact extremely rare. The true frequency of this symptom is unclear, epidemiological data in this field are limited. Itch in malignant disease may additionally impair patients' quality of life. A population-based cohort study showed that chronic itch without concomitant skin changes is a risk factor for having undiagnosed hematologic and bile duct malignancies. Paraneoplastic itch is rather resistant to treatment. In 2012, an interdisciplinary interest group of physicians and researchers was founded, aiming to generate a clear definition of paraneoplastic itch. In this paper we briefly review the current knowledge and aim to define what can be summarized under the term "paraneoplastic itch".

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“…A response was achieved in 80% of these patients, with reductions in both the DLQI and VAS scores. Although these differences were not statistically significant, in view of the small number of patients, they were quantifiable [10]. …”

Section: Case Presentationmentioning

confidence: 99%

“…In none of the studies reviewed was any evidence found of adverse reactions that might have resulted from the continued use of aprepitant [7-10]. …”

Section: Case Presentationmentioning

confidence: 99%

Paraneoplastic pruritus presenting with Hodgkin’s lymphoma: a case report

et al. 2014

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IntroductionParaneoplastic pruritus is defined as pruritus that occurs before or during the natural evolution of a hematologic disease. The reported prevalence is 30% in patients with Hodgkin’s lymphoma. The severity of this pruritus has a very negative impact on patients’ quality of life. Very few studies have been made to examine the efficacy of pharmacological treatments for this type of pruritus. One drug that appears to be effective in this respect is off-label aprepitant, a neurokinin 1 receptor antagonist.Case presentationA 20-year-old Caucasian woman presented with lateral neck nodes, sweating, and pruritus and was diagnosed with stage IIB nodular sclerosis Hodgkin’s lymphoma. Throughout this period during the disease the pruritus was ever-present. Improvement was achieved with some of the chemotherapy treatments, but the symptom returned when the various treatments were withdrawn due to disease progression or poor tolerance. In the middle of the seventh year, she was admitted to our hospital with uncontrolled pruritus that resulted in severe lesions due to scratching. In response, aprepitant (off-label) 80mg/day was added to the chemotherapic treatment of the pruritus, after studying the various treatment options. She reported a score of 9 on a visual analogue scale for the pruritus, and a score of 3 on the Eastern Cooperative Oncology Group performance status scale of performance status. After two weeks of treatment with aprepitant, she reported a score of 5 on the visual analogue scale for the pruritus, and this improved to a score of 4 in a month, which allowed her to lead a better quality of life, with an Eastern Cooperative Oncology Group performance status score between 1 and 2.ConclusionsSeveral cases and case series have been reported on the use of aprepitant for paraneoplastic pruritus, but none have referred to its use for Hodgkin’s lymphoma. A prospective study was carried out to evaluate the efficacy of this drug in refractory pruritus secondary to Sezary syndrome, and other authors have studied the effectiveness of aprepitant against pruritus, secondary to biological therapy with erlotinib. In our case report, treatment was started with daily doses of aprepitant 80mg. Pruritus improvement appeared to be attributable exclusively to the administration of aprepitant.

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Oral aprepitant in the therapy of refractory pruritus in erythrodermic cutaneous T-cell lymphoma

Cited by 56 publications

References 12 publications

Itch Mechanisms and Circuits

Itch Mechanisms and Circuits

Paraneoplastic Itch: An Expert Position Statement from the Special Interest Group (SIG) of the International Forum on the Study of Itch (IFSI)

Paraneoplastic pruritus presenting with Hodgkin’s lymphoma: a case report

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