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Meta-Analysis
. 2013 Nov;69(5):708-720.
doi: 10.1016/j.jaad.2013.06.038. Epub 2013 Aug 24.

Pruritus in patients treated with targeted cancer therapies: systematic review and meta-analysis

Courtney J Ensslin  1 , Alyx C Rosen  1 , Shenhong Wu  2 , Mario E Lacouture  3
Affiliations
Meta-Analysis

Pruritus in patients treated with targeted cancer therapies: systematic review and meta-analysis

Courtney J Ensslin et al. J Am Acad Dermatol. 2013 Nov.

Abstract

Background: Pruritus has been anecdotally described in association with targeted cancer therapies. The risk of pruritus has not been systematically ascertained.

Objective: A systematic review and meta-analysis of the literature was conducted for axitinib, cetuximab, dasatinib, erlotinib, everolimus, gefitinib, imatinib, ipilimumab, lapatinib, nilotinib, panitumumab, pazopanib, rituximab, sorafenib, temsirolimus, tositumomab, vandetanib, and vemurafenib.

Methods: Databases from PubMed, Web of Science (January 1998 through July 2012), and American Society of Clinical Oncology abstracts (2004 through 2012) were searched. Incidence and relative risk of pruritus were calculated using random- or fixed-effects model.

Results: The incidences of all-grade and high-grade pruritus were 17.4% (95% confidence interval 16.0%-19.0%) and 1.4% (95% confidence interval 1.2%-1.6%), respectively. There was an increased risk of all-grade pruritus (relative risk 2.90 [95% confidence interval 1.76-4.77, P < .001]) and variation among different drugs (P < .001).

Limitations: The reporting of pruritus may vary, resulting from concomitant medications, comorbidities, and underlying malignancies. We found a higher incidence of pruritus in patients with solid tumors, concordant with those targeted therapies with the highest pruritus incidences.

Conclusion: There is a significant risk of developing pruritus in patients receiving targeted therapies. To prevent suboptimal dosing and decreased quality of life, patients should be counseled and treated against this untoward symptom.

Keywords: AE; B-lymphocyte antigen cluster of differentiation 20; Bcr-Abl; CD20; CI; CTLA4; EGFR; EGFRIs; HER2; QoL; RR; Raf; T-lymphocyte antigen 4; VEGFR; adverse events; cancer; confidence interval; epidermal growth factor receptor; epidermal growth factor receptor inhibitors; human epidermal growth factor receptor 2; inhibitor; itch; mammalian target of rapamycin; pruritus; quality of life; relative risk; vascular endothelial growth factor receptor.

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Conflict of interest statement

Conflict of interests:

Dr. Lacouture has a consultant role with AstraZeneca, Roche, Bayer, Exelixis, and Advancell. He is also receiving research funding from Berg, Roche. Dr. Wu has received honoraria from Onyx Pharmaceuticals, Pfizer, Jansen, and Novartis, and is a speaker for Onyx, Pfizer, Jansen, and Novartis.

Figures

Figure 1
Figure 1
Selection process for studies included in the meta-analysis.
Figure 2
Figure 2
Relative risk of all-grade (A) and high-grade (B) pruritus associated with targeted therapies versus controls. RR was calculated using a random-effects model. The relative risk for each study is displayed numerically on the left and graphically on the right. Under study name, the first author’s name and publication year were used to represent each trial. The size of the squares is directly proportional to the amount of information available. For individual trials: filled-in square, incidence; lines, 95% confidence interval; diamond plot, overall results of the included trials.
Figure 2
Figure 2
Relative risk of all-grade (A) and high-grade (B) pruritus associated with targeted therapies versus controls. RR was calculated using a random-effects model. The relative risk for each study is displayed numerically on the left and graphically on the right. Under study name, the first author’s name and publication year were used to represent each trial. The size of the squares is directly proportional to the amount of information available. For individual trials: filled-in square, incidence; lines, 95% confidence interval; diamond plot, overall results of the included trials.
Figure 3
Figure 3
Pruritus-induced excoriations associated with use of targeted therapies. Left panel: Excoriations induced by pruritus affecting anterior chest, abdomen, and upper legs; right panel: ventral arm and wrist, showing excoriations induced from pruritus.
See this image and copyright information in PMC

Comment in

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