Pruritus and xerodermia in patients treated with checkpoint inhibitors for melanoma, lung and renal cancer: a meta-analysis

Abstract Background: Dermatologic adverse events (DAEs) are common in patients treated with immune checkpoint inhibitors (ICI) for cancer. Objective: To evaluate the incidence of two selected dermatologic adverse events (DAEs), pruritus and xerodermia, reported as adverse events in phase 3 randomised clinical trials using ICI in patients with lung cancer, renal cancer, and melanoma. Methods: Phase 3 studies where treatment included an ICI in the experimental arm were analysed. For pruritus, 42 studies were analysed with a total of 29,502 evaluable patients. For xerodermia, the number of studies was 23 with 17,341 patients. Results:. Pruritus was associated with ICI therapy with OR of 3.02 (95% CI 2.57–3.55). Compared to renal cell carcinoma (RCC) treated with anti-programmed death (PD-1) agents, patients with melanoma had higher odds of reporting pruritus, reaching statistical significance for the anti-PD-1 and anti-cytotoxic T-lymphocyte associated protein 4 (CTLA4) treatment. Patient with lung cancer had significantly lower odds of pruritus across all ICI types compared to other analysed tumour types. Xerodermia was also associated with ICI treatment. Using RCC/PD-1 as a reference, there was a trend to higher incidence of xerodermia in patients with melanoma. Patients with lung cancer had significantly lower odds of xerodermia regardless of ICI type. Conclusion: The present systematic analysis indicates that pruritus and xerodermia are associated with ICI treatment of any type compared to non-immunologic therapies. There appears to be a higher incidence of these DAEs in patients with melanoma and RCC compared to patients with lung cancer.