IgE blockade with omalizumab reduces pruritus related to immune checkpoint inhibitors and anti-HER2 therapies

D. M. Barrios; G. S. Phillips; A. N. Geisler; S. R. Trelles; A. Markova; S. J. Noor; E. A. Quigley; H. C. Haliasos; A. P. Moy; A. M. Schram; J. Bromberg; S. A. Funt; M. H. Voss; A. Drilon; M. D. Hellmann; E. A. Comen; S. Narala; A. B. Patel; M. Wetzel; J. Y. Jung; D. Y.M. Leung; M. E. Lacouture

doi:10.1016/j.annonc.2021.02.016

IgE blockade with omalizumab reduces pruritus related to immune checkpoint inhibitors and anti-HER2 therapies

D. M. Barrios, G. S. Phillips, A. N. Geisler, S. R. Trelles, A. Markova, S. J. Noor, E. A. Quigley, H. C. Haliasos, A. P. Moy, A. M. Schram, J. Bromberg, S. A. Funt, M. H. Voss, A. Drilon, M. D. Hellmann, E. A. Comen, S. Narala, A. B. Patel, M. Wetzel, J. Y. JungD. Y.M. Leung, M. E. Lacouture

Research output: Contribution to journal › Article › peer-review

22 Scopus citations

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.

Original language	English (US)
Pages (from-to)	736-745
Number of pages	10
Journal	Annals of Oncology
Volume	32
Issue number	6
DOIs	https://doi.org/10.1016/j.annonc.2021.02.016
State	Published - Jun 2021
Externally published	Yes

Keywords

IgE
bullous pemphigoid
cutaneous adverse event
eczema
pruritus
urticaria

ASJC Scopus subject areas

Hematology
Oncology

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10.1016/j.annonc.2021.02.016

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Barrios, D. M., Phillips, G. S., Geisler, A. N., Trelles, S. R., Markova, A., Noor, S. J., Quigley, E. A., Haliasos, H. C., Moy, A. P., Schram, A. M., Bromberg, J., Funt, S. A., Voss, M. H., Drilon, A., Hellmann, M. D., Comen, E. A., Narala, S., Patel, A. B., Wetzel, M., ... Lacouture, M. E. (2021). IgE blockade with omalizumab reduces pruritus related to immune checkpoint inhibitors and anti-HER2 therapies. Annals of Oncology, 32(6), 736-745. https://doi.org/10.1016/j.annonc.2021.02.016

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 2021, 'IgE blockade with omalizumab reduces pruritus related to immune checkpoint inhibitors and anti-HER2 therapies', Annals of Oncology, vol. 32, no. 6, pp. 736-745. https://doi.org/10.1016/j.annonc.2021.02.016

@article{1a94a2fe16324fa885b4597cd0a6799d,

title = "IgE blockade with omalizumab reduces pruritus related to immune checkpoint inhibitors and anti-HER2 therapies",

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.",

keywords = "IgE, bullous pemphigoid, cutaneous adverse event, eczema, pruritus, urticaria",

author = "Barrios, {D. M.} and Phillips, {G. S.} and Geisler, {A. N.} and Trelles, {S. R.} and A. Markova and Noor, {S. J.} and Quigley, {E. A.} and Haliasos, {H. C.} and Moy, {A. P.} and Schram, {A. M.} and J. Bromberg and Funt, {S. A.} and Voss, {M. H.} and A. Drilon and Hellmann, {M. D.} and Comen, {E. A.} and S. Narala and Patel, {A. B.} and M. Wetzel and Jung, {J. Y.} and Leung, {D. Y.M.} and Lacouture, {M. E.}",

note = "Publisher Copyright: {\textcopyright} 2021 European Society for Medical Oncology",

year = "2021",

month = jun,

doi = "10.1016/j.annonc.2021.02.016",

language = "English (US)",

volume = "32",

pages = "736--745",

journal = "Annals of Oncology",

issn = "0923-7534",

publisher = "Oxford University Press",

number = "6",

}

TY - JOUR

T1 - IgE blockade with omalizumab reduces pruritus related to immune checkpoint inhibitors and anti-HER2 therapies

AU - Barrios, D. M.

AU - Phillips, G. S.

AU - Geisler, A. N.

AU - Trelles, S. R.

AU - Markova, A.

AU - Noor, S. J.

AU - Quigley, E. A.

AU - Haliasos, H. C.

AU - Moy, A. P.

AU - Schram, A. M.

AU - Bromberg, J.

AU - Funt, S. A.

AU - Voss, M. H.

AU - Drilon, A.

AU - Hellmann, M. D.

AU - Comen, E. A.

AU - Narala, S.

AU - Patel, A. B.

AU - Wetzel, M.

AU - Jung, J. Y.

AU - Leung, D. Y.M.

AU - Lacouture, M. E.

PY - 2021/6

Y1 - 2021/6

N2 - 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.

AB - 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.

KW - IgE

KW - bullous pemphigoid

KW - cutaneous adverse event

KW - eczema

KW - pruritus

KW - urticaria

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U2 - 10.1016/j.annonc.2021.02.016

DO - 10.1016/j.annonc.2021.02.016

M3 - Article

C2 - 33667669

AN - SCOPUS:85103484740

SN - 0923-7534

VL - 32

SP - 736

EP - 745

JO - Annals of Oncology

JF - Annals of Oncology

IS - 6

ER -

IgE blockade with omalizumab reduces pruritus related to immune checkpoint inhibitors and anti-HER2 therapies

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