UK Study Details Skin Cancer Risks for MPN Patients
Several studies have confirmed the association of ruxolitinib (a JAK inhibitor) with increased risk of non-melanoma skin cancers (NMSCs). A study published in a January 2024 issue of the journal Blood reports on just how serious the risks might be, specifically among patients living with essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF). And they encourage vigilance of monitoring and education across the MPN community of patients and clinicians.
“Non-melanoma skin cancers in ruxolitinib-treated patients with myeloproliferative neoplasms (MPNs) behave aggressively, with adverse features and high recurrence. In our cohort, mortality from metastatic NMSC exceeded that from myelofibrosis,” the UK study authors report.
The more we learn about thrombosis and cardiovascular risks in MPN patients, the more we are able to study how to prevent them. Laboratory research is the key to identification and trials of new and better solutions.
Non-melanoma skin cancers include basal, squamous, and Merkel. Melanoma is a cancer that develops in the skin’s melanocytes.
Ruxolitinib can be effective in reducing spleen volume and symptom burden as well as potentially prolonging survival in responding patients. “However, benefits need to be balanced against potential toxicities…” the authors suggest.
“Our study highlights the aggressive nature of NMSCs in ruxolitinib-treated patients with MPN, the importance of counseling patients about the risk of skin cancer before starting ruxolitinib, and a requirement for close dermatological monitoring on treatment.”
Optimal MF management following diagnosis of NMSC remains uncertain, according to the authors. “Stopping ruxolitinib may result in MF (myelofibrosis) symptom flare and potentially increase the risk of disease progression, and it is not yet clear whether ruxolitinib cessation (or switching to an alternative JAK inhibitor) impacts NMSC outcomes. Consequently, if a patient develops an NMSC while taking ruxolitinib, the risks and benefits of each treatment option need to be carefully weighed and discussed with the patient, acknowledging the uncertainties alluded to above, before deciding whether to change therapy.”
Larger, prospective collaborative studies are needed to better understand NMSC risk and outcomes in ruxolitinib-treated patients with MPN, the report concludes, as are similar evaluations of NMSC risk in patients with MPN treated with other JAK inhibitors.