Related Experiment Video
Updated: May 21, 2025
The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
Published on: July 11, 2013
Prescribing practices among psoriasis experts for patients with concomitant malignancy: a survey of International
Stephanie Bowe1, Michelle Murphy1, John Bourke1
1South Infirmary Victoria University Hospital, Cork, Ireland.
Background:
The management of moderate-to-severe psoriasis in patients with concurrent or previous malignancy presents a unique clinical challenge. Despite the transformative impact of biologic therapies on psoriasis treatment, the exclusion of patients with malignancy from clinical trials has led to a paucity of data regarding the safety and efficacy of systemic and biologic agents in this subgroup. Clinicians are thus often compelled to rely on registry data, real-world evidence and expert opinion when navigating these complex cases.
Objectives:
To investigate prescribing practices among psoriasis experts for systemic and biologic therapies in patients with severe psoriasis and concomitant malignancy. The study aimed to elucidate trends in decision making, perceptions of treatment risks and adherence to multidisciplinary approaches.
Methods:
An electronic survey was disseminated to 141 members of the International Psoriasis Council (IPC) between December 2023 and June 2024. The self-administered questionnaire examined respondents' demographics, guideline familiarity and preferences for systemic and biologic therapies across five malignancy types (breast cancer, melanoma, prostate cancer, lymphoma and metastatic renal cell carcinoma) at varying remission intervals. Data were analysed descriptively.
Results:
Fifty-seven IPC councillors completed the survey (40%). Anti-interleukin-17 agents were the most commonly selected therapies across all malignancy scenarios for patients in remission, reflecting growing confidence in their safety profiles. For active malignancies, apremilast was the most frequently chosen agent, particularly for breast cancer (61%), melanoma (56%) and metastatic renal cell carcinoma (49%). Tumour necrosis factor-α inhibitors and fumaric acid esters were the least frequently selected treatments for active malignancies. The majority of respondents (70%) believed current guidelines lacked clarity on treating psoriasis in the context of malignancy. Nearly half (49%) reported always consulting oncology teams before initiating systemic therapy for patients with recent malignancy diagnoses, underscoring the importance of a multidisciplinary approach.
Conclusions:
This study highlights significant variability in prescribing practices and a strong preference for biologics such as anti-IL-17 agents and apremilast. The findings underscore the urgent need for malignancy-specific guidelines informed by robust long-term safety data to support optimal decision making and improve patient outcomes.
Related Concept Videos
01:30Skin Cancer
Basal Cell Carcinoma (BCC): BCC is the most common type of skin cancer, accounting for about 80% of cases. It typically develops in...
02:50Combination Therapies and Personalized Medicine
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...
01:27Nursing Ethical Principles II
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
01:26Peptic Ulcer Disease IV: Management
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current...
02:49Cancer Therapies
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...