Genitourinary cancers (GUCs) encompass malignancies affecting the urinary and reproductive systems, including renal cell carcinoma (RCC), urothelial carcinoma (UC), and prostate cancer (PC). With the rapidly evolving therapeutic domain of these cancers, cutaneous adverse events (AEs) remain among the most observed toxicities.
To explore the dermatologic AEs linked to novel GUC treatments, their underlying pathophysiology, clinical presentations, and risk factors.
A narrative review of the literature from PubMed and Embase databases was conducted. The search strategy included dermatologic/cutaneous adverse events, risk factors, and pathophysiology in conjunction with the following classes of therapies; immune checkpoint inhibitors (ICIs), antiangiogenic therapies, enfortumab vedotin (EV), erdafitinib, and androgen receptor antagonists (ARAs).
Maculopapular rash, pruritus, and alopecia are present among the five classes of therapies. ICIs demonstrate the highest incidence of severe drug AEs including Steven Johnson syndrome/toxic epidermal necrolysis. Unique cutaneous AEs present with specific therapies including hand-foot skin reaction and subungual splinter hemorrhage with antiangiogenic drugs, stomatitis/mucositis and onycholysis with erdafitinib. Incidence and type of cutaneous AE also differed within therapies in the same class as seen with apalutamide displaying the highest risk of cutaneous AEs within ARAs. Risk factors for development of cutaneous AEs can be general to therapies, or specific, and include age, immune status, BMI, and gender.
Dermatologic AEs may impact patients' quality of life and increase the tendency to hold or discontinue life-saving therapies, underscoring the need for vigilant monitoring, early recognition, and collaborative management between medical oncologists, pharmacists, and dermatologist.
Critical reviews in oncology/hematology. 2024 Jun 19 [Epub ahead of print]
Rachel Daher, Andrew Ruplin, Shilpa Gupta, Philippe E Spiess, Ashish M Kamat, Antonio Cigliola, Valentina Tateo, Chiara Mercinelli, Petros Grivas, Andrea Necchi
Vita-Salute San Raffaele University, Milan, Italy. Electronic address: ., University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA., Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy., Vita-Salute San Raffaele University, Milan, Italy; Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.