Many cancer patients suffer from unendurable itching from the release of proteins by the cells and radiation therapy that kills skin cells and causes dryness and burning as the skin peels off. The unbearable itching severely damages their quality of life.
But there is good news from researchers at the clinical immunology and allergy unit at Hadassah-University Medical Center in Jerusalem’s Ein Kerem. They suggested the drug Dupixent (dupilumab) as an effective treatment for the problem.
“The itch rules the patient’s days and nights,” said Prof. Yuval Tal, director of the clinical immunology unit. “The medicine we developed is a safe treatment and has shown impressive effectiveness by halting the itching after just a few doses.”
The study aimed at eradicating chronic pruritus attracted great international interest after it was presented at the annual conference of the European Association for Clinical Immunology and Allergy in Hamburg and was published in the Journal of Allergy and Clinical Immunology: Global under the title “Dupilumab for cancer-associated refractory pruritus.”
Patients describe diffuse and incessant itching that significantly impair their daily functioning and routine, even though no visual findings, rashes, or changes in skin color appear on the body’s surface. The continuous act of itching leads to self-injury even during sleep. This resistant itch does not respond to conventional treatments, such as steroids, phototherapy, and antihistamines. It disturbs patients so much that they often say, “I’d rather die of cancer and stop scratching.”
The phenomenon mostly affects people suffering from hematologic (blood) cancer, but it exists in cancer patients of all types. Since there are no preliminary signs on the skin’s surface, some are suspected of suffering from psychogenic itching and sent for various tests to understand the phenomenon. The treatments sometimes include steroids in high doses, which not only do not sufficiently relieve the itching, but rather, they cause a wide range of side effects that affect many systems in the body, including the skin.
The clinical study was led by Tal and Dr. Aviv Talmon, a senior physician in Hadassah’s clinical immunology unit who worked in close collaboration with Prof. Michal Lotem of the oncology division and Dr. Shlomo Elias of the hematology division. The efficacy of a biological treatment approved for the treatment of other medical conditions was examined based on the hypothesis of the molecular mechanism that causes the condition.
The treatment's effectiveness
In practice, the effectiveness of this treatment has been shown in three patients with different malignancies and anti-cancer therapies.
“The study examined three different patients with different malignancies, all three of whom had itching at a level of nine to 10 (out of 10) in the itching scale, which is, by definition, the worst itching that can be described,” Tal was quoted as saying.
The three patients received the drug Dupixent (dupilumab), which is known to block the effect of the immune system’s “allergic arm” proteins, IL-4 and IL-13, and decreases the production of cytokine-IL-31, commonly known as the “itch cytokine.” The proteins directly affect the nerve cells that transmit the itching message to the brain, so giving dupilumab prevents nerve transmission and the itching sensation.
The drug was originally intended and approved for treating severe asthma patients and patients with atopic dermatitis from the age of six in Israel and six months in the US. It was submitted to the Health Ministry’s health basket committee this year for additional indications.
This is the first and only published study in which the effectiveness of dupilumab treatment has been tested for a target population of cancer patients who were suffering from itching resulting from malignancy or treatments for this disease, the authors wrote.
A clinically significant response was achieved in all three patients after receiving the first injection, and all of them showed a very impressive response after a third injection to the point where the itching disappeared completely. Two of the patients have since received the treatment regularly, and the drug’s effect continues with the same effectiveness, the study said.
The third patient, a 32-year-old man, did not receive approval to continue the medication, and the itching returned with the same intensity after discontinuing treatment. The unit’s doctors are working to obtain the drug for compassionate use.
“In this preliminary work, we demonstrated that dupilumab treatment is safe and effective in patients with severe and resistant itching associated with malignancies or treatment,” Tal said. “A prospective clinical study aimed at treating secondary itching to the disease and its treatments has been conducted over the past year. We are trying to show in a large group of patients the efficacy and safety of the drug and uncover the proposed molecular mechanism. It is given to all study participants, and we call on patients from all over the country suffering from resistant oncological itching to participate in the study. We will do everything possible to help any patient who contacts us.”