背景:泌尿生殖系统癌症(GUC)包括影响泌尿和生殖系统的恶性肿瘤,包括肾细胞癌(RCC),尿路上皮癌(UC),前列腺癌(PC)。随着这些癌症治疗领域的快速发展,皮肤不良事件(AE)仍然是观察到的最多的毒性。
目的:探讨与新型GUC治疗相关的皮肤病学不良事件,它们潜在的病理生理学,临床表现,和风险因素。
方法:对PubMed和Embase数据库中的文献进行叙述性综述。搜索策略包括皮肤病/皮肤不良事件,危险因素,和病理生理学结合以下类别的疗法;免疫检查点抑制剂(ICIs),抗血管生成疗法,enfortumabvedotin(EV),erdafitinib,和雄激素受体拮抗剂(ARAs)。
结果:斑丘疹,瘙痒,脱发出现在五类疗法中。ICIs显示包括StevenJohnson综合征/中毒性表皮坏死松解症在内的严重药物AE的发生率最高。独特的皮肤AE表现为特定疗法,包括手足皮肤反应和抗血管生成药物的甲下碎片出血。用erdafitinib治疗口腔炎/粘膜炎和甲溶解。皮肤AE的发生率和类型在相同类别的治疗中也不同,如阿帕鲁胺在ARA中显示出皮肤AE的最高风险。发生皮肤AE的危险因素可能是治疗的一般因素,或具体,包括年龄,免疫状态,BMI,和性别。
结论:皮肤不良事件可能会影响患者的生活质量,并增加维持或停止挽救生命疗法的趋势,强调需要警惕监测,早期识别,和医学肿瘤学家之间的协作管理,药剂师,和皮肤科医生。
BACKGROUND: 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.
OBJECTIVE: To explore the dermatologic AEs linked to novel GUC treatments, their underlying pathophysiology, clinical presentations, and risk factors.
METHODS: 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).
RESULTS: 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.
CONCLUSIONS: Dermatologic AEs may impact patients\' quality of life and increase the tendency to dose reduce, hold or discontinue life-saving therapies, underscoring the need for vigilant monitoring, early recognition, and collaborative management between medical oncologists, pharmacists, dermatologists and other specialists.