A 10-year retrospective cohort analysis characterized the risk of nonmelanoma skin cancers (NMSCs) in patients receiving ruxolitinib for polycythemia vera (PV) or myelofibrosis (MF), with results suggesting skin cancer surveillance is appropriate for patients with these conditions who are treated with ruxolitinib. Findings of this study were reported in the Journal of the American Academy of Dermatology.
This study included patients treated at Stanford Medical Center in California who received a PV, MF, or post-PV MF diagnosis between January 1, 2010, and January 1, 2020. Patients were divided at a 1:2 ratio into a ruxolitinib-exposed group and a group without ruxolitinib exposure. They were considered to have had exposure to ruxolitinib after 4 or more weeks of treatment with it. The 2 groups were propensity score matched for age, gender, race, Charlson comorbidity index, myeloproliferative disorder diagnosis, and follow-up duration. The covariate-adjusted hazard ratio for development of an NMSC with ruxolitinib exposure was the main study outcome.
The ruxolitinib-exposed group included 188 patients, and the unexposed group consisted of 376 patients. Overall mean age at diagnosis of PV or MF was 65.5 years (SD, 13.2).
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Six percent of patients in the ruxolitinib-exposed group developed NMSCs. Incidence rate of NMSC was 72.12 per 1000 person-years (95% CI, 45.72-108.21) for ruxolitinib-exposed patients, with a median time to a first NMSC diagnosis after treatment initiation of 66.5 weeks (range, 11 to 245). In the unexposed group, incidence rate was 33.27 per 1000 person-years (95% CI, 23.87-45.13).
In patients with PV or MF with ruxolitinib exposure, the adjusted hazard ratio (aHR) for NMSC was 2.69 (95% CI, 1.03-7.02). For squamous cell carcinoma, it was 3.24 (95% CI, 1.45-7.22); and for basal cell carcinoma, there did not seem to be an increased risk for ruxolitinib-exposed patients (aHR, 1.60; 95% CI, 0.37-7.01).
The risk of squamous cell carcinoma appeared to be worse for ruxolitinib-exposed patients with non-JAK2-mutated disease (aHR, 7.40; 95% CI, 2.54-21.63). Adjusted HR for NMSC overall in ruxolitinib-exposed patients with non-JAK2-mutated disease was 5.65 (95% CI, 1.70-18.75).
Immunosuppression history was another factor that appeared linked to NMSC development, independently of ruxolitinib exposure. The HR for NMSC with an immunosuppression history was 5.39 (95% CI, 1.34-21.61).
“Based on the finding that the earliest diagnosis of first NMSC after ruxolitinib initiation was 11 weeks after, referral to a dermatologist for a skin cancer screening and surveillance within a period of months after ruxolitinib initiation would be reasonable,” the study investigators concluded in their report.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Lin JQ, Li SQ, Li S, et al. A 10-year retrospective cohort study of ruxolitinib and association with non-melanoma skin cancer in polycythemia vera and myelofibrosis patients. J Am Acad Dermatol. Accepted manuscript. Published online October 11, 2021. doi:10.1016/j.jaad.2021.10.004
