INDIVIDUAL ARTICLE: NECOM 4: Algorithm Integrating Skincare for the Management of Immunotherapy-Related Cutaneous Adverse Events for Cancer Patients and Survivors

August 2024 | Volume 23 | Issue 8 | 85411s3 | Copyright © August 2024


Published online July 30, 2024

Ada Girnita MD PhDa, Cynthia Fournier MD FRCPCb, Peter Bjerring MD PhD FEADVc, Sampsa Kauppi MDd, Anneke Andriessen PhDe, Charles Lynde MD FRCPCf, Maxwell Sauder MD FRCPC DABDg, Andreas Stensvold MD PhDh

aSkin Cancer Center Karolinska University Hospital Stockholm, Sweden
bRoyal College of Physicians and Surgeons of Canada; Dermatologist, Hôtel-Dieu-de-Lévis, Lévis, QC, Canada
cDepartment of Dermatology, Aalborg University Hospital, Aalborg, Denmark
dPrivate Practice, Terveystalo and Epilaser Oy, Finland
eRadboud UMC; Nijmegen and Andriessen Consultants, Malden, The Netherlands
fAmerican Board of Dermatology; Royal College of Physicians and Surgeons of Canada; Department of Medicine University of Toronto, Toronto, ON, Canada; Lynderm Research, Markham, ON, Canada
gAmerican Board of Dermatology; Royal College of Physicians and Surgeons of Canada; Department of Medicine University of Toronto; Onco-dermatologist, Princess Margaret Cancer Centre, Toronto, ON, Canada
hMedical Strategy and Development, Østfold Hospital Trust, Norway

Abstract
Background: In the Nordic European Countries, cancer is the leading cause of death. The last decade has brought revolutionizing cancer treatments including immune checkpoint inhibitors (ICIs). Patients on ICIs have a high risk of developing cutaneous immune-related adverse events. Treating these side effects is of high importance to improve patient's quality of life (QoL) and continue the anti-cancer treatment.
Methods: The Nordic European Cutaneous Oncodermatology Management (NECOM) project develops tools to prevent and treat cancer therapy-related cutaneous adverse events (cAEs). The first 2 NECOM papers presented various cAEs and skincare regimens involving hygiene, moisturization, sun protection, and camouflage products for preventing and managing cAEs. The NECOM 3 practical algorithm was on the prevention and treatment of acute radiation dermatitis. This NECOM 4 practical algorithm is intended to prevent and manage cutaneous immunotherapy-related adverse events (cirAEs), improving cancer patients' QoL and outcomes.
Results: The NECOM advisors discussed the results of a systematic literature review and obtained consensus on the evidence and expert opinion-based practical algorithm for cirAEs to support all healthcare providers treating cancer patients in the Nordic European Countries. The algorithm starts with a simple skincare regimen of cleansing, moisturizing, and protection, followed by the exclusion of severe cutaneous adverse reactions, and then specific interventions to treat the most common cirAEs (pruritus, maculopapular eruption, eczematous eruption, psoriasis, lichenoid eruption, and bullous eruption).
Conclusions: CirAEs are the most common side effects induced by ICIs and may lead to cancer treatment interruption or even discontinuation. Patient education on the prevention of cirAEs using a skincare regimen and treatment recommendations given in the NECOM 4 algorithm may help prevent and manage cirAEs and improve the QoL and outcome of patients receiving ICIs.

J Drugs Dermatol. 2024;23:8(Suppl 2):s4-10.

INTRODUCTION

Cancer is the leading cause of death in most countries, including Norway, Sweden, and Finland.1 Cancer incidence and mortality are still growing worldwide with the aging and growth of the population.1 The estimated global incidence of cancer per 100,000 population in 2020 in Denmark was 350, Norway 325, Sweden 285, Finland 270, and Iceland 260.2 In these Northern European countries, prostate cancer and breast cancer are the most diagnosed cancers in males and females, respectively.1 Breast, lung, colon, and prostate cancers are the most common cancers in the five Nordic European countries excluding non-melanoma skin cancers (NMSC).3 According to mortality, lung and prostate are the leading causes of cancer death.1 Cancer is an important cause of morbidity secondary to the cancer itself and adverse events induced by cancer treatments. Early detection and quality of cancer treatments have significantly improved cancer outcomes, leading to more patients living with cancer or surviving cancer.3

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, leading Professor Honjo and Professor Allison who discovered ICIs to be awarded the 2018 Nobel Prize in Physiology or Medicine.4 ICIs are monoclonal antibodies targeting cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), programmed cell death protein 1 (PD-1), programmed death ligand 1 (PD-L1), or lymphocyte-activation gene 3 (LAG-3) (Table 1). There are numerous indications for ICIs in a neo-adjuvant, adjuvant, and curative setting. Immunotherapy is now approved for more than fifteen cancer sites such as melanoma, small cell and non-small cell lung cancer, renal cancer, and triple-negative breast cancer.5,6 Indications for ICIs continue to grow.

Cancer cells have ways to evade body immune surveillance. ICIs are antibodies targeting negative regulators of T cell activation, thus removing the brakes on the immune system and leading to the activation of host T cells to attack cancer. ICIs-activated
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