Malignancy concerns with psoriasis treatments using phototherapy, methotrexate, cyclosporin, and biologics: facts and controversies
Section snippets
The risk of cancer in psoriasis: the issue of comorbidities
Cancer is one of several comorbidities that have been linked with psoriasis. Before discussing the available data, some methodologic difficulties involved when studying cancer association should be considered. The first is related to the overall rarity of most cancers. The incidence of cancer is usually much less than a few cases per 10,000 people/year; hence, a large sample of patients should be recruited and followed up prospectively to document associations in a reliable way. A further
Cancer and treatment for psoriasis: methodologic challenges
Psoriasis is a chronic, recurrent disease. Continuous or rotational treatment is usually required to maintain clearance, and relapse is a regular feature once treatment is stopped. Timing of exposure, its duration, the cumulative dose, interaction with other carcinogens or predisposing factors, and latency are all factors to consider when assessing the relation between a purported causative factor such as treatment for psoriasis and cancer. The same methodologic difficulties when dealing with
Treatment-specific cancer risks in psoriasis
Despite the several difficulties that have been mentioned, enough evidence to guide clinical decisions has been accumulated in the last few decades about the relation between selected cancer types and specific treatments for psoriasis. Not surprisingly, in view of its highest incidence rates, the most reliable data concern nonmelanoma skin cancer (NMSC). A large body of evidence indicates that individuals with a personal history of NMSC, especially in younger age groups, have an increased risk
Biologic agents
The biologic agents are a heterogenous group of naturally occurring molecules, mainly proteins, engineered in the laboratory for pharmaceutical use. Because they are processed by the same pathways as naturally occurring proteins in the human body, in principle, biologic agents are expected to offer a better safety margin than most synthetic small molecules. They can also induce a variety of adverse events related with immunotoxic effects. Infections and cancer are the main possible consequences
Conclusions
Because no standard therapeutic approach exists for patients with moderate to severe psoriasis, the benefits and risks of phototherapy or systemic therapy must be weighed carefully for each patient and treatment individualized accordingly. Considering that psoriasis is a lifelong disease, the patient's lifetime cumulative exposure to these agents must be taken into consideration, and cancer risk should be a concern, especially in patients already at higher risk for developing it, such as
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