Profile: Oncodermatology Study Group Print Email

Profile: Oncodermatology Study Group

Study Group Leaders

Study Group Chair Jennifer Choi, MD, is Chief of the Division of Oncodermatology at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago, Illinois, USA. Jennifer directs the Inpatient Dermatology Consult service for the Cancer Center, as well as the comprehensive skin care and skin cancer surveillance program for high-risk patients and all cancer survivors. She directs clinical research trials investigating the prevention and treatment of cancer therapy-related adverse effects and also helps to oversee Northwestern Memorial’s extracorporeal photopheresis unit. Jennifer’s expertise includes recognition and management of chemotherapy adverse effects, such as rashes, very dry skin, itching, nail and hair changes, cutaneous metastases, radiation dermatitis, and infections and toxicities resulting from stem cell or solid organ transplants.

Vice-Chair Mario E. Lacouture, MD, is Director of the Oncodermatology Program at Memorial Sloan Kettering Cancer Center in New York, New York, USA. He has long had an interest in dermatological conditions that result from cancer and its treatments and, in his clinical career, has focused on recognizing and managing adverse conditions that affect the skin, hair, and nails of cancer patients and survivors. These can occur as a result of chemotherapy, radiation therapy, or therapeutic transplants. His research addresses several major components of dermatologic side effects: accurate description and severity grading; effects on quality of life; identification of risk factors; and the development of treatments.



Mission and Goals

MASCC’s Skin Toxicities Study Group was established to develop research and management strategies for skin conditions due to cancer or anticancer drugs. However, the Group’s sphere of interest has broadened in recent years to include adverse effects of cancer and its treatments that affect the hair, nails, and skin. Therefore, the Study Group’s name has been changed, effective in November 2018, to the Oncodermatology Study Group. Dermatological reactions are frequent in those affected by cancer. They can reduce quality of life and require modifications in lifesaving antineoplastic therapy. This interdisciplinary Study Group aims to raise awareness of dermatological conditions in cancer patients and take a leadership role in the emerging field of cancer-related dermatological toxicities.

The objectives of the Study Group include the following:
To identify new targets for the treatment of reactions affecting the skin, hair, and nails
To establish guidelines for management of such adverse effects
To increase cancer patients' knowledge of these adverse reactions and improve self-care

Further aims are to identify high-risk phenotypes and treatment regimens and to promote preventive measures and early intervention as standards of care. This Study Group serves as a resource for multicenter clinical trials and transitional studies, and as a resource for all MASCC members.

Past and Current Projects

Practice Guidelines
The Study Group undertook a project to determine treatment recommendations for the management of skin problems caused by epidermal growth factor receptor (EGFRI) agents. Members of the Study Group reviewed and evaluated research in eight categories of skin toxicity and a selected group of eight experts served as a recommendations panel. Treatment recommendations were based on research findings and expert opinion and resulted in a set of clinical practice guidelines, published in Supportive Care in Cancer in 2011.1 Subsequently, a CME-certified slide set was developed, in which Dr. Lacouture provides a case-based review of the MASCC guidelines for preventing and treating dermatologic toxicities in patients receiving EGFR inhibitors. These publications are available on the Oncodermatology Study Group’s page on our website.

The Study Group has also produced clinical practice guidelines for the prevention and treatment of acute and late radiation reactions. Radiation dermatitis often occurs in the early weeks of radiation treatment, although late effects also occur. It can have a profound effect on patients' quality of life and lead to dose modifications. The evidence-based radiation dermatitis prevention and treatment guidelines specify prevention strategies as well as methods of reducing discomfort and itching and for treating patients with established radiation-induced telangiectasias and fibrosis. The guidelines were published in Supportive Care in Cancer in 2013.2

MASCC EGFR Inhibitor Skin Toxicity Tool© (MESTT)
Developed in 2008, the MESTT© was designed to assist oncology health professionals with the monitoring and reporting of dermatologic adverse events in patients being treated with EGFRIs. The MESTT is an event-specific grading system that can be used to standardize assessment, optimize the use of EGFR inhibitors, and enable researchers to conduct more informative, controlled studies. The Study Group also developed a brochure that healthcare providers can provide to patients who experience dermatological effects of targeted therapies. The brochure is also available at the Oncodermatology Study Group’s web page.

Cancer-Related Hair Loss Research and Registry
Chemotherapy-induced hair loss is a common and distressing side effect of cancer therapy and presents a major supportive care challenge. Scalp cooling has been shown to be effective in preventing hair loss for many patients. Although the mechanism of action is not certain, it is hypothesized that cooling of the scalp causes cutaneous vasoconstriction, which reduces blood flow to the hair follicles as well as the uptake of chemotherapeutic agents. Cooling also reduces biochemical activity, and this may make hair follicles less susceptible to the effects of chemotherapy. Two 2017 systematic reviews1 have documented the efficacy of scalp cooling for many patients with solid tumors who are receiving various types of chemotherapy, and long-term safety data are now available.2 Several members of MASCC’s Oncodermatology Study Group have led the way in collecting efficacy and safety data and developing information channels for both patients and physicians. A major initiative is the international CHILL registry, which is collecting evidence-based data about scalp cooling to provide patient information and clinical guidance. Four members of the Study Group serve on the CHILL Executive Board. For more information on this initiative, see Hair Loss, Scalp Cooling, and the CHILL Registry on the MASCC website and CHILL: Cancer-related Hair Loss International Leadership and Linkage.

Publications, Presentations, Workshop

Presentations
Members of the Study Group have collaborated on Annual Meeting presentations in 2016 (Adelaide), 2017 (Washington, DC), and 2018 (Vienna), as well as a Pre-Conference Workshop in 2018 (Vienna). The 2018 meeting featured a Parallel Session on Advances in Oncodermatology: Prevention and Management of Dermatologic Toxicities, led by Jennifer Choi, MD, and Mario Lacouture, MD. More information and slide sets are available at 2018 MASCC/ISOO Annual Meeting Presentations.

2018 Workshop: Update and New Developments in Supportive Care of Patients with Chemotherapy-Induced Alopecia
Over the past two years, new information has emerged about the use of scalp-cooling devices to prevent chemotherapy-induced alopecia. The workshop provided an update on new developments and recommendations for the management of chemotherapy-induced alopecia. The workshop was led by Mario Lacouture, MD.

Books and Book Chapters
Members of the Study Group have contributed to two chapters in the Second Edition of the MASCC Textbook on Cancer Supportive Care and Survivorship: Chapter 37, Dermatological Adverse Events, and Chapter 38, Management of Alopecia Due to Cancer Therapies. Their work reflects the fact that the development of new systemic therapies has resulted in many new skin reactions that require management.

Publications
Recent journal publications have focused on the prevention and management of adverse events associated with targeted therapies and immunotherapies that affect the skin, oral mucosa, hair, and nails. Two recent articles by Study Group members are highlighted in this issue. For a list of recent publications, see the Study Group’s Publication Page on our website.

In addition to research papers, Study Group Vice Chair Mario Lacouture has published two books:

  • Dr. Lacouture’s Skin Care Guide for People Living with Cancer (Harborside Press, 2012). The book provides clear information and practical suggestions for preventing, treating, and living through skin, hair, and nail changes. It is designed to help patients care for treatment-associated skin, hair, and nail toxicities, which can range from mild and irritating to serious enough to affect health, treatment, and quality of life.

  • Dermatologic Principles and Practice in Oncology: Conditions of the Skin, Hair, and Nails in Cancer Patients (Wiley-Blackwell, 2014). This is the first book to focus on common and frequently disabling dermatological side effects in cancer patients. It provides detailed descriptions of the mechanisms of action of current oncology drugs, as well as their dermatological side effects. The book also includes treatment recommendations for improving the care of patients with cancer. Several members of the Oncodermatology Study Group contributed chapters to this book, including Jennifer Choi, MD, Milan Anadkat, MD, and Vincent Sibaud, MD.

Cancer Treatment-Related Adverse Events Symposium

Study Group Vice Chair Mario Lacouture directs the Annual Cancer Treatment-Related Adverse Events Symposium, which was held in both 2017 and 2018 at Memorial Sloan Kettering Cancer Center in New York City, NY. The Symposium provides up-to-date information on adverse-event mechanisms and management of the most common side effects. Its goals are to increase knowledge about grading adverse events, to understand their mechanisms in order to improve interventions, and to increase awareness of clinical tools to assess treatment-related toxicities.

The 2019 Annual Cancer Treatment-Related Adverse Events Symposium will be held on October 25-26 at Memorial Sloan Kettering Cancer Center. It is intended for oncology physicians, physician assistants, nurses, pharmacists, and other professionals involved in the care of cancer patients. Registration will be available online soon at mskcc.org/cme.

Future Projects

  • Practice Guidelines. The Oncodermatology Study Group is currently working on establishing multidisciplinary clinical practice guidelines for the management of adverse events induced by checkpoint inhibitors. This is being accomplished with the collaboration of key thought leaders from various other disciplines, including gastroenterology, endocrinology, pulmonology, rheumatology, nephrology, and hematology/oncology. The focus of these guidelines will be on specific recommendations geared toward specialists for the higher grade 3-4 reactions. 
  • Chemotherapy-Induced Alopecia. The Study Group is preparing a manuscript characterizing permanent chemotherapy-induced alopecia, based on almost 200 cases. This will be a valuable manuscript describing a common phenomenon that is in need of further research.
  • Post-Radiation Alopecia. Another project under development is that of characterizing hair loss secondary to radiation and hair-sparing radiation methods. MASCC members can get involved by contacting the Chair, Vice-Chair, or other members of the Oncodermatology Study Group if they have cases that can add to this upcoming project.

In general, the Study Group leaders encourage any MASCC member to collaborate with the Oncodermatology team regarding any interesting research questions or projects pertaining to cancer care and its effects on skin, hair, or nails.

Chair Jennifer Choi shared her thoughts about the importance of oncodermatology research to supportive cancer care. “As cancer treatments continue to evolve, most recently with the emphasis on immunotherapy and its combination therapies with traditional cytotoxic chemotherapies, we see more and more how effects on the skin, hair, and nails are among the most prevalent toxic effects on the body. We are continuing to understand the impact these changes have both physically and psychosocially on the patient. Additionally, because the skin is among the most accessible of our organs in terms of tissue research, the field of oncodermatology is also being advanced through critical translational research. Supportive cancer care will continue to become stronger as rigorous clinical and translational research in oncodermatology help us better understand the mechanisms of these toxic effects and ways to prevent or manage them.”
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1Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Lacouture ME, Anadkat MJ, Bensadoun RJ, Bryce J, Chan A, Epstein JB, et al; for MASCC Skin Toxicity Study Group. Support Care Cancer. 2011 Aug;19(8):1079-95.
2Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group. Wong RK, Bensadoun RJ, Boers-Doets CB, Bryce J, Chan A, Epstein JB, Eaby-Sandy B, Lacouture ME. Support Care Cancer. 2013 Oct;21(10):2933-48.