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Skin Toxicity in Advanced Cancer Treatments

Understanding Cutaneous Reactions in Advanced Cancer Treatments

In 2021, an estimated 229,200 Canadians were diagnosed with cancer. Lung cancer, among the four most commonly diagnosed types of cancer (lung, breast, colorectal, and prostate), remains the most lethal. Immunotherapy, a groundbreaking cancer treatment, activates the body's immune system to fight cancer by preventing T cells from being deactivated, allowing them to recognize and attack cancer cells. These treatments are approved for nearly every type of solid-organ tumor, many hematologic malignancies, and often as first-line therapy.

In the United States, approximately 40% of oncology patients were eligible for immunotherapy in 2019. Oncology patients treated with immunotherapy may experience cutaneous immunotherapy-related adverse events (cirAEs), which can significantly impact quality of life and cancer treatment outcomes.​​​

Join Dr. Joël Claveau as he delves into the complexities of targeted therapy and immunotherapy. These treatments, known for their effectiveness, also come with potential side effects, especially dermatological reactions.

  • Dermatological Reactions: Insight into skin, hair, nails, and eye reactions associated with immunotherapy.

  • Incidence and Onset of cirAEs: Variability based on drug class, type of cancer, and patient-related factors.

  • Common cirAEs: Frequent occurrences include pruritus, lichen planus, psoriasiform reactions, eczematoid eruptions, morbilliform eruptions, and bullous diseases.

  • Therapeutic Response Indications: Certain cirAEs may indicate a positive therapeutic response and predict survival outcomes.

Understanding Cutaneous Reactions in Advanced Cancer Treatments

Proactive Measures

Rash Prevention:
  • Assess for pre-existing conditions (e.g., psoriasis, acne vulgaris, rosacea)

  • Encourage hydration

  • Use alcohol-free emollients

  • Apply broad-spectrum sunscreen (UVA, UVB)

Dry Skin and Fissure Care:
  • Use tepid water

  • Use mild soaps and bath oils

  • Apply moisturizers several times a day

  • Wear protective footwear

  • Avoid hot water, frequent bathing, and alcohol-containing lotions

Management of Severe Reactions:
  • Ensure skin toxicity is not life-threatening

  • Manage with topical and systemic steroids if necessary

  • Sometimes temporarily interrupt immunotherapy


Dr. Joel Claveau’s Approach:
  1. Preventative Dermocosmetic Regime:

    • Hygiene + moisturizer + sun protection + camouflage

  2. Treatment Modalities:

    • Radiation

    • Chemotherapy

    • Targeted therapy

    • Immunotherapy

    • Hormonal therapy

    • Surgery

    • Transplant

CaSMO Management of Cutaneous Toxicities Associated with Immune Checkpoint Inhibitors:
A Practical Primer

The CaSMO advisors created a practical guide on the prevention, identification, and treatment of cirAEs, with a focus on skincare for conditions like isolated pruritus, psoriasiform eruptions, lichenoid eruptions, eczematous eruptions, and bullous pemphigoid. The development of this guide followed a modified Delphi approach. The recommendations provided by the CaSMO advisors are informed by guidelines, algorithms, consensus papers, and systematic reviews, as well as their clinical experience and discussions.

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Dr. Joël Claveau, Diplomate of the American Board of Dermatology, Fellow of the Royal College of Physicians of Canada, Associate Professor, Department of Medicine, Laval University, Director of Melanoma and Skin Clinic, Le Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Quebec City, QC, Canada. Dr. Maxwell B. Sauder, Onco-dermatologist, Princess Margaret Cancer Centre, Director, Toronto, ON, Canada. Dr. Charles W. Lynde, Fellow of the Royal College of Physicians of Canada, Diplomate of the American Board of Dermatology, Associate Professor, Department of Medicine, University of Toronto, Toronto, ON, Canada, Lynderm Research, Markham, ON, Canada. Dr. Anneke Andriessen, Radboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands. Dr. Tarek Hijal, Fellow of the Royal College of Physicians of Canada, Associate Professor, Department of Oncology, McGill University; Director, Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada. Dr. Nicole M. C. Clemens, Medical Oncologist, Medical Oncology Disease Site Lead for Melanoma/Skin Oncology, Princess Margaret Cancer Centre. Assistant Professor, Department of Medicine, University of Toronto, Associate Member, Department of Immunology, University of Toronto, Toronto, ON, Canada. Lacouture ME, et al. Support Care Cancer. 2011;19(8):1079-95. Robert C, et al. Lancet Oncology 2015;16(4):e181-9. Canadian Skin Management in Oncology (CaSMO)

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Making awareness and education available is crucial. Since 2006, the Foundation has worked to raise awareness of melanoma and non-melanoma skin cancers focusing on education, prevention and the need for improved patient care.

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