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

BACKGROUND: Pruritus 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. METHODS: PubMed 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. FINDINGS: A 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. INTERPRETATION: Treatment 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.