Can gene expression help to pick the right biologic to treat psoriasis in cancer patients?

A study assessing gene expression in cancer patients revealed both benefit and harm for cancer prognosis from high or low TNF, IL-17A, and IL-23A expression. This conceptual approach may influence future management of dermatologic patients with malignancies [1].

Biologics like TNF blockers or inhibitors of IL-17A and IL-23 have started a new era of possible achievements in psoriasis treatment. However, there is a worrisome and ongoing discussion about an increased risk of cancer linked to psoriasis management with agents in these drug classes. “Clinicians and dermatologists often face difficult decisions in prescribing these drugs, especially to those who have a history of cancer or those who have a current active cancer,” said Dr Nikolai Klebanov (Brigham and Women’s Hospital, USA).

To gain further insight, a theoretical and hypothesis-generating, observational retrospective study was performed using The Cancer Genome Atlas (TCGA). Over 9,000 patients suffering from 27 different cancer types were categorised into those with low or high expression of TNF, IL-17, and IL-23 (cut-off was median gene expression per gene). A possible correlation was analysed between cancer survival and gene expression.

An improved survival with a low HR was seen only in patients with renal cell carcinoma and low IL-23A expression (531 total events; HR 0.53; adjusted P<0.0033). In cutaneous melanoma and sarcoma, a low expression of TNF had a negative impact on cancer survival (total events 430; HR 1.65; adjusted P=0.0168; and total events 262, HR 1.92; adjusted P=0.0495). These findings suggest that TNF-inhibitor use could be harmful in patients with active melanoma or sarcoma, as Dr Klebanov commented.

In view of these interesting findings about potential cancer and biologics in psoriasis treatment, the authors saw a need for further studies that comprise testing for possible confounders by creating multivariate models, for example. “Hopefully, with future human or animal studies we could have a better idea of the safety of these medications for these sorts of patients,” stated Dr Klebanov.

1. Perez-Chada L, et al. Late-breaking abstract, AAD Virtual Meeting Experience, 12-14 June 2020.

Posted on 6 August 20205 January 2021