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Cancer immunotherapy may cause skin-related side effects: Who are most likely to experiencing them?

Cancer immunotherapy may cause skin-related side effects: Who are most likely to experiencing them?
Patients receiving chemotherapy and advanced stage cancer patients are also at risk for mucormycosis.

Cancer patients receiving immune checkpoint inhibitors may developed skin problems like itching, inflammation, rash, skin colour loss, swelling or blisters. But clinicians should avoid prescribing corticosteroids to treat these skin problems. Researchers explain why?

Written by Longjam Dineshwori |Updated : April 15, 2021 12:23 PM IST

Immunotherapies have transformed treatment for many advanced cancers, but the medications may lead to various side effects. Immunotherapy uses the power of the body's own immune system to fight cancer. Different types of immunotherapy are used to treat cancer including immune checkpoint inhibitors, T-cell transfer therapy, monoclonal antibodies, treatment vaccines, and immune system modulators. Immune checkpoint inhibitors are drugs that allow immune cells to respond more strongly to cancer cells by blocking immune checkpoints. These immune checkpoints are proteins that keep immune responses from being too strong and sometimes stop T cells from killing tumour cells. But several studies have linked the use of immune checkpoint inhibitors for cancer treatment with adverse events, most commonly involving the skin. In a new study, researchers have identified some of the skin-related side effects due to immune checkpoint inhibitors, and also provided insights on which patients may be more likely to experience them.

Led by investigators at Massachusetts General Hospital (MGH), the study was published in the Journal of the American Academy of Dermatology. For the study, the team looked at the health data of 8,637 patients who were treated with immune checkpoint inhibitors and an equal number of cancer patients who did not receive these medications. After analysing the data, they found that only 10 of over 40 skin conditions previously linked to the use of immune checkpoint inhibitors actually occur at a higher incidence among patients on these medications compared with those who aren't using the drugs. Early symptoms associated with these conditions include itching, inflammation, rash, skin colour loss, swelling or blisters.

Who are more likely develop skin problems after immunotherapy?

According to the study, patients with melanoma or kidney cancer and those receiving multiple types of immune checkpoint inhibitors were more likely to develop skin-related side effects due to immune checkpoint inhibitors. The overall incidence of skin-related side effects among the participants was found to be 25.1 per cent, with a median time of onset of 113 days.

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Clinicians often prescribe systemic corticosteroids to treat these skin problems, but researchers suggested that these drugs should be avoided as that they may blunt the anti-tumour effects of immunotherapy. They noted that clinicians caring for patients receiving immune checkpoint inhibitors should be on the lookout for the skin problems as patients continue taking the medications. Dermatologists and oncologists can work together to identify the vulnerable patients so that steps can be taken to prevent progression to more severe toxicities, they added.

Common side effects of immunotherapy

Immunotherapy can cause different side effects, depending on the type of treatment, the type and location of the cancer, and a person's general health. So it is advisable to talk to your doctor about the possible side effects of immunotherapy before the start the treatment. Here are some common side effects of immunotherapy:

Flu-like symptoms: - Fatigue (feeling tired), fever, chills, weakness, nausea (feeling sick to your stomach), vomiting (throwing up), dizziness, body aches, and high or low blood pressure.

Skin reactions: -Pain and swelling at the needle site, skin redness, blistering, and dryness. In addition, the skin on the fingertips may crack. Your skin may also become more sensitive to sunlight. Due to scratching, the skin may break and become more prone to infections. Some patients may experience inflammation around the nails that can make grooming, dressing, and other activities painful or difficult.

Other side effects: Other not so common side effects of immunotherapy include swelling and weight gain from retaining fluid, heart palpitations, sinus congestion, diarrhoea, risk of infection, and organ inflammation.

Though rare, some types of immunotherapy may lead to severe or even fatal allergic and inflammation-related reactions.

With inputs from agencies