Search

Bruton's tyrosine kinase (BTK) inhibitors, such as ibrutinib, acalabrutinib, and zanubrutinib, are commonly used to treat chronic lymphocytic leukemia (CLL), Waldenström macroglobulinemia, and mantle cell lymphoma. These inhibitors can cause cutaneous adverse events, including ecchymoses, skin infections, and hair and nail changes. Edema, or swelling, has been reported in 5-29% of patients treated with BTK inhibitors, but it has not been well classified. This article presents two cases of persistent upper extremity edema in patients on BTK inhibitor therapy and discusses the possible mechanisms and management of this side effect. [Extracted from the article]

Background Cutaneous immune-related adverse events (cirAEs) are the most common toxicities to occur in the setting of immune checkpoint inhibitor (ICI) therapy. Identifying patients who are at increased risk of developing cirAEs may improve quality of life and outcomes. Objectives To investigate the influence of cancer type and histology on the development of cirAEs in the setting of ICI therapy and survival outcomes. Methods This retrospective cohort study included patients recruited between 1 December 2011 and 30 October 2020. They received ICI from 2011 to 2020 with follow-up of outcomes through October 2021. We identified 3668 recipients of ICI therapy who were seen at Massachusetts General Brigham and Dana-Farber. Of these, 669 developed cirAEs. Records that were incomplete or categories of insufficient sample size were excluded from the study cohort. Multivariate Cox proportional hazards models were used to investigate the impact of cancer organ system and histology on cirAE development, after adjusting for demographics, Charlson Comorbidity Index, ICI type, cancer stage at ICI initiation, and year of ICI initiation. Time-varying Cox proportional hazards modelling was used to examine the impact of cirAE development on mortality. Results Compared with other nonepithelial cancers (neuroendocrine, leukaemia, lymphoma, myeloma, sarcoma and central nervous system malignancies), cutaneous squamous cell carcinoma [cSCC; hazard ratio (HR) 3.57, P < 0.001], melanoma (HR 2.09, P < 0.001), head and neck adenocarcinoma (HR 2.13, P = 0.009), genitourinary transitional cell carcinoma (HR 2.15, P < 0.001) and genitourinary adenocarcinoma (HR 1.53, P = 0.037) were at significantly higher risk of cirAEs in multivariate analyses. The increased risk of cirAEs translated into an adjusted survival benefit for melanoma (HR 0.37, P < 0.001) and cSCC (HR 0.51, P = 0.011). Conclusions The highest rate of cirAEs and subsequent survival benefits were observed in cutaneous malignancies treated with ICI therapies. This study improves our understanding of patients who are at highest risk of developing cirAEs and would, therefore, benefit from appropriate counselling and closer monitoring by their oncologists and dermatologists throughout their ICI therapy. Limitations include its retrospective nature and cohort from one geography. [ABSTRACT FROM AUTHOR]

This article presents the findings of a study on the effects of reducing surgical margins in the excision of cutaneous melanoma. The study compared outcomes of excision with reduced margins to those recommended by the American National Comprehensive Cancer Network (NCCN). The analysis included 1825 patients with early-stage melanoma. The results showed that while some cases deviated from recommended margins, particularly in the head and neck region, margin reduction did not independently lead to worse recurrence-free survival or overall survival. The study emphasizes the difficulty of achieving sufficient margin control in anatomically complex and functionally important areas. Further research is needed to validate these findings and guide clinical practice. [Extracted from the article]