Targeted therapies for psoriasis and atopic dermatitis in the context of malignancy: SPIN-FRT recommendations

The expanding use of biologic and oral targeted therapies has transformed the management of psoriasis and atopic dermatitis. These agents are increasingly prescribed to patients with current malignancy, a history of malignancy or an increased cancer risk, populations typically excluded from clinical trials. In the absence of robust long-term safety data, clinicians often rely on real-world evidence to inform treatment decisions.

To review the evidence regarding malignancy risk associated with biologic and oral targeted therapies used in psoriasis and atopic dermatitis and to provide expert consensus recommendations for patients with current malignancy, previous malignancy or increased risk of malignancy.

We describe the physiological roles of key immune pathways targeted in psoriasis and atopic dermatitis, as well as in cancer immunosurveillance, tumour progression and immune escape. We then summarize evidence from randomized controlled trials regarding the risk of de novo malignancy, followed by a synthesis of real-world data addressing cancer recurrence and progression in patients treated with biologic and oral targeted therapies.

Available evidence suggests that the overall malignancy risk associated with most biologic and oral targeted therapies used in psoriasis and atopic dermatitis is low, although differences between therapeutic classes may exist. Real-world data remain limited for several therapeutic classes and in patients with active or previous malignancy.

Based on the available evidence, we present consensus-based recommendations developed by a multidisciplinary expert panel convened by the Skin Inflammation & Psoriasis International Network-Fondation René Touraine (SPIN-FRT). These recommendations aim to support treatment decisions by balancing disease control with potential cancer-related risks while highlighting key evidence gaps.