Introduction: Immunotherapy has revolutionised cancer treatment. However, these advancements are accompanied by various adverse effects, notably pruritus, which can significantly impact patients' quality of life and treatment adherence. Pruritus is a common adverse event associated with immunotherapy, especially in regimens like ipilimumab combined with nivolumab, where reported incidences can reach up to 33%.
Aim: This review explores strategies for managing immunotherapy-induced pruritus in oncological patients.
Methods: To conduct a systematic review, utilising three key databases—MEDLINE, EMBASE, and CINHAL—using terms specifically related to immunotherapy and pruritus. The inclusion criteria were limited to English-language articles published within the last five years, focusing on literature that provided insights into management strategies.
Results: After conducting a scoping review focused on management strategies and eliminating duplicates, irrelevant publications, and those published outside the 5-year timeframe, 8 relevant articles remained. These articles included 3 case series/case reports and three retrospective cohort studies, providing data on 253 patients affected by immunotherapy-induced pruritus. Patients with bullous pemphigoid or other immunotherapy-induced rashes were not included.
The studies highlighted various management approaches, including antihistamines, topical regimes, and oral prednisolone. One multicentre retrospective report included 34 patients with immunotherapy-induced pruritus treated with omalizumab. Omalizumab resulted in a decrease in patients who required oral corticosteroids from 50% to 9%.
A total of 6 patients have been described to use dupilumab to treat pruritus.
Currently, there is no long-term data.
Discussion: Treatment options include antihistamines, topical steroids, and oral steroids. For treatment-resistant cases, consideration of dupilumab and omalizumab is warranted. Omalizumab showed successful treatment outcomes in 35 patients compared to 6 patients treated with dupilumab. An in-depth systematic review will be conducted. Additional data and larger patient cohorts are required to validate the safety and efficacy of these treatments.