Acta Dermato-Venereologica 99-4CompleteContent | Page 18

INVESTIGATIVE REPORT Pruritus in Patients Under Targeted Anticancer Therapy: A Multi­ dimensional Analysis Using the 5-D Itch Scale Soo Ick CHO 1,2 , Jaewon LEE 1,2 , Jin LIM 3 , Jong Seo PARK 1,2 , Miso KIM 3 , Tae-Yong KIM 3 , Tae Min KIM 3 , Kyung-Hun LEE 3 , Bhumsuk KEAM 3 , Sae-Won HAN 3 and Seong Jin JO 1,2 1 Department of Dermatology and 3 Department of Internal Medicine, Seoul National University Hospital, Seoul, and 2 Center for Skin Cancer and Adverse Skin Reaction to Chemotherapeutics, Seoul National University Cancer Hospital, Seoul, Republic of Korea Pruritus is a very common symptom in patients, un- dergoing targeted anticancer therapy. However, the characteristics of pruritus, according to the targeted anticancer agents, are still unclear. The objective of this study was to determine the characteristics of pru- ritus, induced by targeted anticancer agents, using a questionnaire-based survey. The survey was adminis- tered to cancer patients currently receiving anticancer agents. Medical records were also reviewed. A total of 374 cancer patients completed the survey, of which 108 were treated with the targeted therapy. A total of 205 patients had pruritus, of which 66 were under the targeted therapy. Epidermal growth factor recep- tor inhibitor (EGFRI) users showed the highest pre- valence rate of itching and numeric rating scale score for itching. The 5-D itch score was also highest among users of EGFRIs. In conclusion, patients receiving EG- FRIs suffer from severe pruritus frequently. They not only experienced long lasting and intense itching, cau- sing sleep discomfort, but also developed itching at specific body sites. Key words: chemotherapy; adverse drug reaction; pruritus. Accepted Jan 23, 2019; E-published Jan 23, 2019 Acta Derm Venereol 2019; 99: 435–441. 435 Corr: Seong Jin Jo, MD, PhD, Department of Dermatology, Seoul National University Hospital and Center for Skin Cancer and Adverse Skin Reaction to Chemotherapeutics, Seoul National University Cancer Hospital, 101 Daehag-ro, Jongro-gu, Seoul, Korea. E-mail: [email protected] C ancer patients, who receive anticancer agents, fre- quently suffer from various systemic toxicities, such as nausea, mucositis, myelosuppression, and many cuta- neous manifestations, including pruritus (1, 2). Pruritus, an unpleasant sensation provoking the desire to scratch, is one of the most common cutaneous symptoms mani- fested during the anticancer therapy (3). It was reported that around 20–30% of patients, undergoing anticancer treatment, suffer from pruritus (4, 5). In these patients, pruritus could affect not only the quality of life (QoL) but also the clinical outcome of anticancer therapy, as severe pruritus induced by treatments would require dose modification or even discontinuation of the anticancer agents (4, 6). Recently, targeted anticancer therapies, including small-molecule tyrosine kinase inhibitors (TKIs) and monoclonal antibodies (mAbs), were developed and suc- SIGNIFICANCE Pruritus is a common symptom in patients undergoing tar- geted anticancer therapy. In this study, we aimed to assess the features of pruritus in patients undergoing targeted anticancer. A total of 374 cancer patients completed the survey, of which 108 were treated with targeted therapy. A total of 205 (54.8%) patients had pruritus, of which 66 were under targeted therapy. Epidermal growth factor re- ceptor inhibitor users showed the highest prevalence rate of itching, NRS score for itching and 5-D itch score. This study showed that patients receiving epidermal growth fac- tor inhibitors suffer from pruritus frequently and severely. cessfully approved for the treatment of breast, colorectal, lung, and various other cancers (7, 8). In contrast to the classic anticancer chemotherapy that non-specifically damages cancer cells, as well as rapidly proliferating nor- mal cells, the new targeted anticancer agents selectively block signal pathways associated with specific cancer growth and progression, thus successfully reducing sys- temic adverse events (9). However, targeted anticancer agents frequently induce cutaneous side effects, resulting in clinical problems for oncologists and dermatologists (2, 9). In particular, drug-induced pruritus has been re- ported to occur more frequently with targeted anticancer agents than non-targeted agents (4, 10, 11). Some investigators surveyed the incidence of pruritus, during anticancer therapy, by measuring the severity of pruritus based on a visual analogue scale (VAS) or the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE) (11–13). These tools are useful and precise in assessing the severity of pruritus, although they do not include other aspects of the symptom, such as the location and the impact on QoL. Moreover, there is a lack of studies, which focus on the association between the symptom and type of targeted anticancer agents that are classified according to the receptor signalling they target, such as epidermal growth factor receptor (EGFR, also known as ErbB1), vascular endothelial growth factor receptor (VEGFR), human epidermal growth factor receptor 2 (HER2, also known as ErbB2), etc. Each agent has its own mechanism of action, and the clinical aspects of pruritus induced by a certain targeted anticancer agent might be different from that induced by others (11, 14). This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3129 Acta Derm Venereol 2019; 99: 435–441