Cutaneous pigmentary changes related to anticancer therapy in African Americans.

Abstract

12074 Background: Pigmentary disorders are known to disproportionately affect individuals with darker skin, including African Americans (AAs)— a historically underrepresented population in oncology research. However, reports on the prevalence and characterization of anticancer-therapy related cutaneous pigmentary changes in this population are lacking. Methods: A retrospective analysis of AA cancer patients that ever received a hematopoietic stem cell transplantation (HSCT) and/or systemic oncologic therapy within six months prior to diagnosis of cutaneous hypo- or hyperpigmentation at our institution between 4/18/2012 and 8/26/2019 was conducted. Clinical and management characteristics were summarized; severity of pigmentary changes was assessed using the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v.5.0). Results: From a total of 1342 AA patients evaluated by oncodermatologists during the study period, 121 (9%) met inclusion criteria. Average age in this cohort was 52, and 102 (84%) were women. Breast (63, 52%), gastrointestinal (14, 12%), and hematologic malignancies (13, 11%) comprised the majority of cancer diagnoses. Most (93, 77%) patients had skin hyperpigmentation (84, 69%) or hypopigmentation (9, 7%) as a primary CTCAE diagnosis; the rest had secondary post-inflammatory hyperpigmentation (28, 23%). A higher proportion (105, 87%) of pigmentary alterations was attributed to single agents [i.e. chemo- (55, 46%), radiation (16, 13%), targeted (12, 10%), endocrine (9, 7%), and supportive oncologic (6, 5%) therapy] versus combination treatment (16, 13%). Five (4%) patients had graft versus host disease associated with allogeneic HSCT, four (80%) of which presented as cutaneous hypopigmentation. Hand foot syndrome (24, 20%), acneiform rash (24, 20%), and radiation dermatitis (16, 13%) were commonly diagnosed dermatologic adverse events (dAEs), generally classified as mild/grade 1 (67, 55%) in severity. For management, skin lightening agents +/- emollients (36, 30%) or emollients alone (25, 21%) were highly recommended. Topical corticosteroids +/- emollients were prescribed just as frequently as reassurance and/or avoidance of sun exposure (22, 18%). Conclusions: Cutaneous pigmentary changes related to cytotoxic chemotherapy, radiation and/or targeted oncologic therapy are common in AA cancer patients. Undertreatment of these dAEs, possibly due to under-recognition in darker skin, warrants further investigation to assess impact on quality of life and help improve management in this population.