IL‐17A inhibitors in patients with chronic plaque psoriasis and history of malignancy: A case series with systematic literature review

Abstract

The treatment of moderate to severe plaque psoriasis in patients with history of malignancy is challenging. To review the studies reporting the experience with IL-17A inhibitors in patients with psoriasis and history of malignancy; secondly, to investigate cancer recurrence in a series of patients with a prior malignancy and plaque psoriasis treated with IL-17A inhibitors. A systematic literature review and an observational retrospective analysis of patients with history of malignancy and plaque psoriasis treated with IL-17A inhibitors was performed. About 5 original articles out of 601 were retrieved, reporting a total of 10 patients with a median age of 59 years, interquartile range (IQR) 50-63. Seven patients were treated with secukinumab, one with ixekizumab and two with both sequentially. Although the stage ranged from in situ to IV stage, most of the cases were early-stage neoplasm. The IL-17A inhibitor was initiated after a median of 10 months, interquartile range (IQR) 5-30 (range 0-144) from the diagnosis of malignancy. In addition, a series of 12 patients with history of malignancy were identified from the University Hospital of Verona, including 9 cases with cancer in clinical remission and 3 with advanced disease at time of initiating IL-17 inhibitor. No malignancy recurrence was reported within a median of 12 (IQR 6-23) and 46 (IQR 36-48) months follow up in case series from literature and our experience, respectively. Data on use of IL-17A inhibitors in patients with chronic plaque psoriasis and history of malignancy are limited. Registries and proactive pharmacovigilance activities are needed to guide clinical practice.

Secukinumab in Patients with Psoriasis and a Personal History of Malignancy: A Multicenter Real-Life Observational Study

“…To date, few reports have described real-life experiences of the use of biological drugs in psoriatic patients with a history of malignancy [13][14][15][16]. All of these were case series limited in sample size, with a total of 75 cases described, and presented overall data on several classes of biologics, not focusing on a specific drug.…”

“…Psoriasis patients with a personal history of malignancy are a special population often excluded from clinical trials investigating biologics. In addition, real-life experiences describing the treatment of such patients with biologics are limited to a few case series [13][14][15][16]. Accordingly, the purpose of our study was to report a multicenter real-life experience of secukinumab treatment in adult patients with moderate-to-severe psoriasis and a history of cancer.…”

Psoriatic patients with a history of cancer: A real‐life experience with Apremilast treatment for 104 weeks

“…Current guidelines indicate consultation with oncologist before starting treatment with biologicals, considering the type and staging of cancer, the risk of recurrence and the burden of psoriasis. 13 Definitely, most guidelines recommend that history of malignancy within 5 years prior to treatment is a contraindication for treatment with biologic agents.…”

“…Current guidelines indicate consultation with oncologist before starting treatment with biologicals, considering the type and staging of cancer, the risk of recurrence and the burden of psoriasis 13 …”

Seven cancer patients receiving guselkumab for treatment of moderate-to-severe psoriasis

“… 1 Recent data show successful treatment on biologics despite concurrent or previous malignancy in psoriatic patients but to date, there are poor experiences about Guselkumab in these patients. 2 , 3 The role of IL-23 in tumorigenesis is contradictory: high levels are correlated with poor prognosis in many human neoplasms, but in contrast, it proved effective in inhibiting cell proliferation in some cases of leukemia. 4 IL-23 inhibitors have shown efficacy and safety in the treatment of psoriasis.…”