Many targeted cancer treatments promote the development of dry skin, called xeroderma or xerosis cutis. A meta-analysis now shows how high the incidence and relative risk actually are.
From three databases, namely PubMed (1966-2013), Web of Science (1998-2013), and American Society of Clinical Oncology abstracts (2004-2013), the researchers collected clinical data on a total of 58 targeted agents used in cancer therapy – including tyrosine kinase inhibitors, monoclonal antibodies, hormone therapeutics, and proteasome inhibitors. In total, they analyzed 99 phase II and 31 phase III trials. The purpose was to determine the incidence and risk of xerosis in this population.
Almost one fifth of patients suffer from dry skin
It is known that pruritus can cause a dose reduction or even an interruption of a targeted cancer therapy. Xerosis, on the other hand, has received less attention as an associated condition, but it promotes destruction of the skin barrier and is thus a key enabler of infection, sensitization, and pruritus.
The incidence rate for grade 1-4 xerosis in the studied population was 17.9% (95% CI 15.6-20.4%). High-grade cases (grade 3) were much less common at 1% (95% CI 0.9-1.5%). Thus, it is also clear that cancer therapy had to be interrupted or reduced in dose only in isolated cases due to the xerosis itself. According to the researchers, newer generation drugs showed less severe manifestations of dry skin.
Overall, the risk of developing xerosis of any degree was increased almost threefold in cancer patients compared with the general population (RR 2.99 [95%-KI 2,0-4,3]). As expected, the values varied significantly depending on the drug used.
Keeping an eye on the dry skin as an accompanying symptom
The authors conclude that patients receiving specific cancer therapy have a significantly increased risk of xerosis.
The power of the study is limited in that the coverage of xerosis varied depending on the treating physician and the institution involved. The incidence is also highly dependent on age, comorbidities, concomitant medications and underlying malignancies, and of course skin condition.
Despite the methodological shortcomings, it makes sense to counsel cancer patients early on regarding this concomitant condition and to treat the dry skin if necessary. Concomitantly, affected individuals should avoid hot/long showers, brush cleansing and skin care products with high pH, fragrances or alcohol.
Keeping the problem of dry skin in mind, limitations in quality of life and adherence problems when taking cancer medications can be avoided at best. The goal is to address dry skin at an early stage to prevent pruritus and subsequent dose reduction or discontinuation of cancer therapy.
Source: Valentine J, et al: Incidence and risk of xerosis with targeted anticancer therapies. JAAD January 27, 2015 [Epub ahead of print].
InFo ONCOLOGY & HEMATOLOGY 2015; 3(6): 5.
