Effects of Targeted Therapies and Immunotherapies on Skin, Oral Mucosa, Hair, and Nails

Toxic Side Effects of Targeted Therapies and Immunotherapies Affecting the Skin, Oral Mucosa, Hair, and Nails

Oncodermatology Study Group Chair Mario Lacouture, MD, and MASCC member Vincent Sibaud, MD, have recently reviewed toxic side effects of targeted therapies and immunotherapies that affect the skin, oral mucosa, hair, and nails.1 Targeted therapies and immunotherapies are associated with a wide array of dermatologic toxicities that result from inhibition of common signaling pathways involved in malignant behavior and normal homeostatic functions of the epidermis and dermis. These include acneiform rash, secondary skin tumors (squamous cell carcinoma), keratoacanthomas, hand-foot skin reactions, maculopapular hypersensitivity-like rash, oral mucosal changes, alopecia, and debilitating nail and periungual damage, among many others. Targeted therapies and immunotherapies often profoundly diminish patients’ quality of life, with significant implications for treatment adherence and outcomes. Even so, only a minority of cancer patients are referred to a dermatologist during their therapy.

Lacouture and Sibaud review numerous toxicities associated with epidermal growth factor receptor inhibitors, anti-MEK, BRAF inhibitors, mTOR inhibitors, immune checkpoint inhibitors, endocrine therapy, and others. They stress the importance of preventive and supportive care, as well as early patient education and early management, which are critical to prevent trauma and to avoid more aggressive treatment later. The authors further urge closer collaboration between oncologists and dermatologists to reduce the severity of oncodermatologic toxicities and maximize the chances for successful treatment outcomes.
1Mario Lacouture and Vincent Sibaud. Am J Clin Dermatol 2018;19(Suppl 1):31-39. Free PMC Article. Mario Lacouture is Director of the Oncodermatology Program at Memorial Sloan Kettering Cancer Center in New York City, USA. Vincent Sibaud is an oncodermatologist and Senior Physician at the Institut Universitaire du Cancer in Toulouse, France.