TOPLINE:
Biologic therapies demonstrated comparable safety to conventional systemic agents in patients with psoriasis who had active cancer or recent cancer history, with similar progression and recurrence rates.
METHODOLOGY:
- To address the limited data available on the safety of biologics in patients with cancer, researchers conducted a retrospective, active comparator-controlled surveillance study of 333 treatment episodes from 174 patients (mean age, 64.8 years; mean age at treatment initiation, 12.5 years; 52.9% female) with psoriasis or psoriatic arthritis who had a concurrent or recent (within 5 years) malignancy.
- The analysis included 160 biologic episodes (89 TNF-alpha inhibitors, 71 newer agents including interleukin [IL]-17 and IL-12/23 or IL-23 inhibitors) compared with 173 conventional systemic or apremilast treatment episodes.
- Primary outcomes were a composite of progression-free survival (PFS) or recurrence-free survival (RFS) and incidence of severe infections requiring hospitalization.
- Participants underwent oncologic surveillance at specialized oncology services.
TAKEAWAY:
- Over a median follow-up of 6 years, the incidence rates of cancer progression or recurrence rates were comparable between the biologic and conventional therapy groups (10.7 vs 10.5 per 100 patient-years), with biologic therapy showing no significant impact on cancer progression (hazard ratio [HR], 1.02; P = .94). The cumulative PFS or RFS at 1 year was 86% in both groups, with no significant differences at 3 and 5 years.
- Independent predictors of progression or recurrence were impaired functional status (HR per 1-point increase in Eastern Cooperative Oncology Group performance score, 1.47; P < .001), advanced cancer stage (HR per stage increment, 1.48; P < .001), and higher comorbidity burden (HR per point increase in the Charlson Comorbidity Index, 1.10; P = .031).
- Nearly 17% vs 23.7% of patients in the biologic group vs the conventional or apremilast treatment group were hospitalized for serious infections (P = .12). IL-17 inhibitors were associated with an increased risk for serious infections (HR, 3.79; P = .002), particularly oroesophageal candidiasis and upper respiratory tract infections.
- During follow-up, 10.2% developed new primary malignancies, with no significant difference between biologic (9.4%) and conventional (11%) treatment groups; the most common were nonmelanoma skin cancer, monoclonal gammopathy, lymphoma, and melanoma.
IN PRACTICE:
“Our findings indicate that biologics exhibit a favorable safety profile in patients with cancer, and treatment choice may be guided more by psoriasis severity than by the presence of malignancy,” the study authors wrote. They noted that current national and international guidelines recommend against initiating biologic therapies in patients with psoriasis who have a history of malignancy within the preceding 5 years.
SOURCE:
The study was led by Danielle Bar, MD, Department of Dermatology, Gray Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel, and was published online on December 17 in the Journal of the American Academy of Dermatology.
LIMITATIONS:
The observational design of the study had inherent limitations. Evaluating cancer progression or recurrence across diverse malignancy types and stages was challenging. Additionally, subgroup analyses had small sample sizes and were hypothesis generating.
DISCLOSURES:
The study did not receive any funding. The authors reported having no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
