Risk of pruritus in cancer patients treated with biological therapies: A systematic review and meta-analysis of clinical trials

• Pruritus has been described with targeted therapies in cancer patients.
• The highest RRs of all-grade pruritus were associated with panitumumab and ipilimumab.
• The RR of all-grade pruritus with anti-EGFR mAbs was 2.84 compared to anti-EGFR/HER2 TKIs and 1.24 to immunotherapy.
• Frequent clinical monitoring of pruritus should be emphasized when managing these and newer targeted agents.

SummaryBackgroundPruritus has been described with targeted therapies in cancer patients. We performed an up-to-date meta-analysis to determine the incidence and RR in patients with cancer treated with these agents.MethodsPubMed databases were searched for articles published till October 2014. Eligible studies were selected according to PRISMA statement. Summary incidence, RR, and 95% CIs were calculated using random-effects or fixed-effects models based on the heterogeneity of selected studies.FindingsA total of 4803 potentially relevant trials were identified; of them, 33 randomized phase III studies were included in this meta-analysis; 20,151 patients treated with 14 distinct targeted agents were available for this analysis; 8816 (44%) had Non-small cell lung cancer (NSCLC) and 12,257 had other malignancies. The highest incidences of all-grade pruritus were observed with panitumumab (56.8) and gefitinib (49.4), while the lowest incidences were reported by erlotinib (3.6) and sunitinib (5.8). In addition, the highest incidence of high-grade pruritus was reported by gefitinib (5.9). The summary RR of developing all-grade and high-grade pruritus with targeted agents vs. controls were 2.2 and 2.6, respectively. The highest RRs of all-grade pruritus were associated with panitumumab (25.6) and ipilimumab (4.5). Grouping by drug category, the RR of all-grade pruritus with anti-EGFR mAbs was 2.84 (95% CI 2.39 to 3.37) compared to anti-EGFR/HER2 TKIs and 1.24 (95% CI 1.03 to 1.49) to immunotherapy.InterpretationTreatment with biological therapy in cancer patients is associated with a significant increase in the risk of pruritus, and frequent clinical monitoring of pruritus should be emphasized when managing these and newer targeted agents.