Omalizumab for cancer-induced dermatoses

Cancer treatment can lead to various dermatologic pathologies in need of therapy. In these often difficult-to-treat disorders, omalizumab could be a safe and efficacious addition to the current armamentarium [1].

In case of difficult-to-treat dermatologic adverse events (AEs) in the course of targeted therapy and immunotherapy for cancer, dermatologists are in demand for consultations. Dermatologic AEs often affect the quality of life of the cancer patients as first-line symptomatic treatment may fail to alleviate the burden of conditions such as urticaria or eczema. A retrospective study was conducted with single-centre data from electronic medical records from 48 cancer patients to assess omalizumab as a possible treatment for these side effects.

Of the 48 participants included, 75% suffered from moderate dermatologic AEs and 25% had severe dermatologic pathologies. In 54% of the cases, these events were caused by cancer treatment with anti-programmed cell death-1 immune checkpoint inhibitors. All of the dermatologic AEs had shown resistance to topical therapy with corticosteroids. The 3 most frequent dermatologic AEs were urticaria (63%), bullous pemphigoid (17%), and eczema (13%).

Response to anti-immunoglobulin E therapy with omalizumab was seen in 94% of the patients. Treatment effects were defined as significant improvement in case of change in severity of dermatologic AEs of ≥2 grades or full resolution. More than half (52%) of the study subjects that had a response to omalizumab treatment achieved this significant improvement. Interestingly, 76% of the patients needed only a single dose of omalizumab for a maximal clinical amelioration.

Successful therapy of the dermatologic AEs also had an impact on the cancer treatment as 78% of 18 patients that had to suspend their oncological therapy due to these AEs were able to be re-treated. In 1 additional case, re-treatment was possible after dose reduction. No life-threatening disorders resulted from omalizumab.

Although the study evaluated omalizumab in an uncontrolled setting, the extent of clinical benefit paired with treatment safety may render omalizumab eligible for the treatment of dermatologic events in cancer patients.

1. Barrios DM, et al. Late-breaking abstract, AAD Virtual Meeting Experience, 12-14 June 2020.

Posted on 6 August, 20205 January, 2021