Skin Cancer More Likely Among Psoriasis Patients Treated with Phototherapy Versus Adalimumab

Risk of psoriasis patients developing non-melanoma skin cancers (NMSCs) is greater among those given phototherapy as opposed to those treated with anti-tumor necrosis factor α (TNFα) agents, according to new findings.¹

This research was led by Emanuele Trovato from the department of medical, surgical and neurological sciences’ dermatology unit at the University of Siena in Italy. Trovato and colleagues highlighted the fact that prior research had suggested those given biologic therapies did not show a direct correlation with increased risk of skin cancer versus non-biologic systemic treated individuals.²

Despite this conclusion, the team did express that it had not been possible to exclude bias connected to prior treatments given to these patients, with phototherapy being one possible example.

“The aim of our study was to evaluate the risk of developing NMSCs in psoriatic patients with a disease duration of less than 6 years, observed for at least 5 years from January 2018 to January 2023, by directly comparing patients only treated with phototherapy and patients treated with anti-TNFα agents, naive to other systemic treatments or phototherapy,” Trovato and colleagues wrote.¹

Study Background

The investigators looked at the data of 200 adults with diagnoses of psoriasis who had been featured at Siena University Hospital, Italy. Those deemed to be eligible for the study were over the age of 18 years and reported a minimum psoriasis disease duration of 6 years.

These subjects were divided into 2 cohorts, with the first being made up of 100 individuals who were given narrow-band UVB phototherapy (nb-UVB) that also used wavelengths of 311–313 nm. The second cohort the team assessed was made up of 100 adults who had been treated with the anti-TNFα therapy adalimumab, with this drug used as it is designated as a first-line treatment.

The first group (Group 1) received nb-UVB phototherapy for a total of 5 years, having had their sessions over a span of 8 weeks at a rate of twice-per-week, with this regimen being followed by a 3-month hiatus, and a total of 160 sessions. The research team noted that the cumulative doses of adalimumab per session had been 8750 mJ/cm².

The investigators also evaluated the minimal erythemal dose (MED) with the goal of guiding the treatment. Those involved in the Group 2 cohort were initially given an 80 mg dose of adalimumab, followed then by a 40 mg dose after a single week, and followed then by 40 mg every 2 weeks for a total of 5 years.

The subjects assessed by the research team were observed annually over the course of 5 years for squamous cell carcinoma (SCC) or basal cell carcinoma (BCC). Additionally, the team defined obesity as having a body mass index (BMI) greater than 30.

Results

Obesity was reported by the investigators as the most common comorbidity among both cohorts, though they found no major distinctions between the 2 study arms regarding the number of obese individuals.

Among the first cohort’s 100 participants treated with phototherapy, 34 were found to have developed at least a single BCC or SCC, with 10 of such subjects reporting 2 skin cancers. There were 5 subjects who had both a BCC and an SCC, while another 5 reported 2 BCCs.

The investigators suggest that the risk of developing non-melanoma skin cancers was, thus, shown to be greater among individuals undergoing phototherapy versus those given anti-TNFα treatment. They added that their research underscores the value of closely monitoring for scalp psoriasis, as such patients might be at an increased risk as well.

“In conclusion, our study represents an important contribution to the evolving narrative on NMSC risk associated with dermatological interventions,” they wrote. “The intersection of treatment modalities, age-related vulnerabilities, and anatomical location forms a picture of complexity that encourages a more complete and precise understanding of this delicate subject.”

References

1. ^{Trovato E, Dragotto M, Capalbo E, Cartocci A, Rubegni P, Calabrese L. Risk of Skin Cancer in Patients with Psoriasis: Single-Center Retrospective Study Comparing Anti-TNFα and Phototherapy. J Clin Med. 2024 Apr 23;13(9):2452. doi: 10.3390/jcm13092452. PMID: 38730981; PMCID: PMC11084754.}
2. ^{Bujoreanu F.C., Bezman L., Radaschin D.S., Niculet E., Bobeica C., Craescu M., Nadasdy T., Jicman D.S., Ardeleanu V., Nwabudike L.C., et al. Nevi, biologics for psoriasis and the risk for skin cancer: A real concern? (Case presentation and short review) Exp. Ther. Med. 2021;22:1354. doi: 10.3892/etm.2021.10789.}