<p>Use of Immunomodulating Drugs and Risk of Cutaneous Melanoma: A Nationwide Nested Case-Control Study</p>

Abstract

Purpose Cutaneous melanoma is among the fastest growing malignancies in Norway and ultraviolet radiation (UVR) exposure is the primary environmental risk factor. Immunomodulating drugs can increase skin photosensitivity and suppress immune responses, and by such mechanisms influence melanoma risk. We, therefore, aimed to examine the associations between use of immunomodulating drugs and melanoma risk, at a nationwide population level. Patients and Methods In the Cancer Registry of Norway, we identified all cases aged 18–85 with a first primary cutaneous melanoma diagnosed in 2007–2015 (n=12,106). These were matched to population controls from the Norwegian National Registry 1:10 (n=118,564), on sex and year of birth using risk set sampling. Information on prescribed drugs (2004–2015) was obtained by linkage to the Norwegian Prescription Database (NorPD). Conditional logistic regression was used to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for associations between use of immunomodulating drugs (immunosuppressants and corticosteroids) and melanoma risk, adjusted for ambient UVR and other drug use. Results Compared with ≤1 prescription, use of ≥8 prescriptions of immunosuppressants was associated with increased risk of melanoma (RR 1.50, 95% CI 1.27, 1.77). Similar associations were found for subgroups of immunosuppressants: drugs typically prescribed to organ transplant recipients (OTRs) (RR 2.02, 95% CI 1.35, 3.03) and methotrexate (RR 1.27, 95% CI 1.04, 1.55). Similar results were found for high levels of cumulative doses and across all histological subtypes. Use of corticosteroids was not associated with melanoma risk. Conclusion We found a positive association between use of immunosuppressants and melanoma risk, with the highest risk seen for drugs prescribed to OTRs. Knowledge about this risk increase is important for physicians and users of these drugs, for intensified surveillance, awareness and cautious sun exposure.

Descriptive analysis of 179 German reports of melanoma reported to an adverse drug reaction database as a drug-related adverse effect, and comparison with melanoma cases contained in German cancer registries

“…As only 24% and 22.9% of MM reports provided information on type and thickness of MM, no firm conclusions could be drawn from the data, and the results are discussed only briefly. Superficial MM was the most frequently diagnosed MM type in the literature, 24 and our results concur with this. Previous reports suggested a higher occurrence of nodular MM in male than female patients 29 as seen in our reports, and nodular MM are more likely to be at a more advanced stage at diagnosis 30 .…”

“…5,23 The literature shows conflicting results with regard to immunosuppressant-associated MMs. Higher risks with higher cumulative doses of immunosuppressants and for anti-tumour necrosis factor (TNF)-a drugs such as adalimumab and etanercept (the two drugs with highest numbers in our analysis) were reported by studies from Norway 24 and Sweden. 25 However, for anti-TNF-a drugs, other studies did not confirm these associations.…”

Incidence of Skin Cancer in Patients With Chronic Inflammatory Cutaneous Diseases on Targeted Therapies: A Systematic Review and Meta-Analysis of Observational Studies

“…Assessing the baseline risk of cutaneous malignancies in psoriasis patients is challenging due to most studies including both treated and untreated patients, and due to confounding factors like phototherapy and immunosuppressive therapy (50). Moreover NMSC and melanoma are known to arise with increased incidence among patients that have undergone medical radiation procedures or immunosuppressive therapy (51)(52)(53), such as those immunosuppressed in an iatrogenic way after a solid organ transplantation (54)(55)(56). According to the World Health Organization, age standardized world incidence of melanoma and NMSC are respectively 3,4 and 11 per 100.000 PYs.…”

Samle, telle, regne, fortolke – tilbakeblikk på Kreftregisterets statistikkproduksjon og forskning gjennom 70 år

“…I tillegg har aktiviteten vokst med forskning knyttet til legemiddelbruk i befolkningen, livskvalitet for kreftpasienter, familiaer genetisk sårbarhet, pakkeforløp i kreftbehandlingen, og sosial ulikhet og kreftrisiko (130)(131)(132)(133)(134)(135). Forskningen er også utvidet til flere kreftformer som tidligere har vaert lite gjenstand for forskning.…”