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Clinical Characterization of Immunotherapy-Related Pruritus Among Patients Seen in 2 Oncodermatology Clinics

Year: 2018

Type: article

Abstract: Immunotherapies are landmark disease-modifying agents in cancer but have the potential to cause adverse events that can lead to treatment interruptions, decreased quality of life (QOL), or morbidity.1 Immunotherapy agents include monoclonal antibodies that target downregulators or checkpoints of the immune response, including cytotoxic T-lymphocyteassociated protein 4 (CTLA-4), programmed cell death 1 (PD1), and programmed death ligand 1 (PD-L1), activating the immune system against tumor cells.Pruritus occurs in 14% to 47% of patients treated with immune checkpoint inhibitors and can range in severity from mild and localized to debilitating and widespread in 1% to 3% of patients.2 Pruritus in various dermatologic conditions is associated with lower QOL, 3 but to our knowledge the repercussions of immunotherapy-related pruritus among patients with cancer have not been reported. Methods | Patients referred to the oncodermatology clinics atMemorial Sloan Kettering Cancer Center in New York City and the University of Naples Federico II in Naples, Italy, for pruritus attributed to immunotherapy between December 1, 2014, and November 30, 2017, were given the ItchyQoL pruritus assessment, visual analog scale, and body distribution diagram.This study was approved by Memorial Sloan Kettering Cancer Center's Institutional Review Board, and written informed consent was obtained from all participants.ItchyQoL is validated to assess QOL regarding pruritus symptoms, functional status, and emotional wellbeing.Each ItchyQoL item is scored from 1 to 5, with higher scores indicating greater burden on QOL. 4 ItchyQoL is reported as a single score consisting of the mean of the responses to all the items.In the visual analog scale, participants rate their degree of itch on a 100-mm horizontal visual analog scale; possible scores range from 0 to 100, with a score of 0 indicating no itch and 100, extreme itch.Relevant clinical and demographic data were abstracted from electronic medical records.Pruritus was graded by following the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE), version 4.0.5 Questionnaire responses and patient data were analyzed using SPSS, version 24 (IBM Corp); a 2-sided P < .05 was considered statistically significant.

Source: JAMA Dermatology

DOI: 10.1001/jamadermatol.2018.4560