Skin Changes - Pruritus

Definition

Pruritus or itch associated with Acneiform rash or Xerosis.1

Incidence

Pruritus is common in patients treated with multikinase inhibitors occurring in 9% to 19% of patients.2-6

Onset

Pruritus onset occurs with the onset of xerosis or rash. Pruritus is often concurrent with rash as a manifestation of cutaneous inflammation and histamine release; and can begin early or later in the course of Multikinase inhibitor therapy, depending on the kinetics and type of cutaneous reaction. In most cases, pruritus is associated with skin xerosis and can be successfully controlled with moisturisers.

Resolution

There are limited data in the literature regarding the resolution of pruritus following multikinase inhibitor therapy as a manifestation of skin inflammation; it usually responds to topical anti-inflammatory measures and moisturisers. Also see management of skin changes, Pruritus.

Grading and Lesion Characteristics

According to the NCI-CTCAE V4.03,7 pruritus is “A disorder characterised by an intense itching sensation”. Grading according to the NCI-CTCAE V4.037 or to MESTT8 is quite similar.

Grade 1 (mild) Pruritus

  • The NCI-CTCAE V4.03 definition of grade 1 pruritus reads: Mild OR localised; topical intervention indicated
  • The MESTT definition of grade 1 pruritus reads: Mild OR localised, intermittent, not requiring therapy

Grade 2 (moderate) Pruritus

  • The NCI-CTCAE V4.03 definition of grade 2 pruritus reads: Intense OR widespread; intermittent; skin changes from scratching (e.g. oedema, papulation, excoriations, lichenification, oozing/crusts); oral intervention indicated; limiting Instrumental ADL
  • The MESTT definition of grade 2A pruritus reads: Moderate localised OR widespread intermittent requiring intervention
  • The MESTT definition of grade 2B pruritus reads: Moderate localised OR widespread constant requiring intervention

Grade 3 (severe) Pruritus

  • The NCI-CTCAE V4.03 definition of grade 3 pruritus reads: Intense OR widespread; constant; limiting self-care ADL or sleep; oral corticosteroid or immunosuppressive therapy indicated
  • The MESTT definition of grade 3 pruritus reads: Severe, widespread constant and interfering with sleep

References

1Lacouture ME, et al. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer. 2011;19:1079-1095.
2Food and Drug Administration. Nexavar® (sorafenib) Prescribing Information 2013.
3European Medicines Agency. Nexavar® (sorafenib) Summary of Product Characteristics 2014.
4Food and Drug Administration. Caprelsa® (vandetanib) Prescribing Information 2014.
5European Medicines Agency. Sutent® (sunitinib) Summary of Product Characteristics 2014.
6European Medicines Agency. Glivec® (imatinib) Summary of Product Characteristics 2014.
7National Cancer Institute Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events and Common Toxicity Criteria [v4.0]. 15-12-2010. (accessed 22 August 2014)
8Multinational Association of Supportive Care in Cancer (MASCC) EGFR Inhibitor Skin Toxicity Tool (MESTT) (accessed 22 August 2014)

Last update: 22 August 2014