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Barrios DM, Phillips GS, Geisler AN, Trelles SR, Markova A, Noor SJ, Quigley EA, Haliasos HC, Moy AP, Schram AM, Bromberg J, Funt SA, Voss MH, Drilon A, Hellmann MD, Comen EA, Narala S, Patel AB, Wetzel M, Jung JY, Leung DYM, Lacouture ME. IgE blockade with omalizumab reduces pruritus related to immune checkpoint inhibitors and anti-HER2 therapies. Ann Oncol 2021; 32:736-745. [PMID: 33667669 PMCID: PMC9282165 DOI: 10.1016/j.annonc.2021.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Immunoglobulin E (IgE) blockade with omalizumab has demonstrated clinical benefit in pruritus-associated dermatoses (e.g. atopic dermatitis, bullous pemphigoid, urticaria). In oncology, pruritus-associated cutaneous adverse events (paCAEs) are frequent with immune checkpoint inhibitors (CPIs) and targeted anti-human epidermal growth factor receptor 2 (HER2) therapies. Thus, we sought to evaluate the efficacy and safety of IgE blockade with omalizumab in cancer patients with refractory paCAEs related to CPIs and anti-HER2 agents. Patients and methods: Patients included in this multicenter retrospective analysis received monthly subcutaneous injections of omalizumab for CPI or anti-HER2 therapy-related grade 2/3 pruritus that was refractory to topical corticosteroids plus at least one additional systemic intervention. To assess clinical response to omalizumab, we used the Common Terminology Criteria for Adverse Events version 5.0. The primary endpoint was defined as reduction in the severity of paCAEs to grade 1/0. Results: A total of 34 patients (50% female, median age 67.5 years) received omalizumab for cancer therapy-related paCAEs (71% CPIs; 29% anti-HER2). All had solid tumors (29% breast, 29% genitourinary, 15% lung, 26% other), and most (n = 18, 64%) presented with an urticarial phenotype. In total, 28 of 34 (82%) patients responded to omalizumab. The proportion of patients receiving oral corticosteroids as supportive treatment for management of paCAEs decreased with IgE blockade, from 50% to 9% (P < 0.001). Ten of 32 (31%) patients had interruption of oncologic therapy due to skin toxicity; four of six (67%) were successfully rechallenged following omalizumab. There were no reports of anaphylaxis or hypersensitivity reactions related to omalizumab. Conclusions: IgE blockade with omalizumab demonstrated clinical efficacy and was well tolerated in cancer patients with pruritus related to CPIs and anti-HER2 therapies.
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Affiliation(s)
- D M Barrios
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - G S Phillips
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A N Geisler
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - S R Trelles
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA
| | - S J Noor
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA
| | - E A Quigley
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA
| | - H C Haliasos
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA
| | - A P Moy
- Department of Dermatology, Weill Cornell Medicine, New York, USA; Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A M Schram
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - J Bromberg
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - S A Funt
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - M H Voss
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - A Drilon
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - M D Hellmann
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - E A Comen
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - S Narala
- Department of Dermatology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
| | - A B Patel
- Department of Dermatology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Wetzel
- Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, USA
| | - J Y Jung
- Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, USA; Dermatology Service, Department of Medical Oncology, Norton Cancer Institute, Louisville, USA
| | - D Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, USA
| | - M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA.
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