Australians with chronic lymphocytic leukaemia continue to have high rates of skin cancer and other second primary malignancies, even as treatment has moved from chemo-immunotherapy to targeted therapies.
The findings from a national study suggest an ongoing need to pay attention to cancer screening and skin cancer prevention in both the primary care setting and the CLL clinic.
The study, published in the Internal Medicine Journal [link here], comprised 111 patients with CLL who received at least two lines of treatment, including ibrutinib monotherapy in second or later lines of therapy, between December 2014 and November 2017 on a ‘Named Patient Program’.
The study found 25.2% of patients developed one or more second primary cancer during follow-up. These included solid malignancies (12.6%), non-melanoma skin cancer (7.2%), melanoma (5.4%) and second haematological malignancies (2.7%).
“Compared with the Australian annual incidence of cancers, melanoma and all cancers (excluding non-melanomatous skin cancers) had SIRs of 15.8 (95% CI: 7.0–35.3) and 4.6 (95% CI:3.1–6.9) respectively,” the study said.
“These data represent the most recent data on melanoma rates in Australian CLL patients and may reflect the increased risk in ageing Australians among the general population, which has tripled in the last 40 years, noting a median age at CLL diagnosis of 62.4 in our study.”
“However, the age-adjusted SIRs remain elevated, suggesting this is not the only contributor to increased risk.”
The investigators, including co-senior authors Associate Professor Eliza Hawkes and Professor Stephen Opat, said long disease duration and multiple lines of treatment may contribute additive cumulative risk.
“Whether the use of any particular CLL therapy significantly impacts the risk of SPM remains uncertain,” they said.
The study said there were currently no recommendations for population-based cancer screening for skin cancers within Australia, due to a lack of high-quality evidence regarding benefit.
“However, the Royal Australian College of General Practice recommends 6–12 monthly skin checks, self-examination and the use of sunscreen for patients at ‘high risk’ of skin cancer as identified by >6 times general risk due to prior skin cancer, history of solid organ transplant or arsenic therapy.”
“Our data suggest that patients with CLL, especially those currently receiving active therapy, would benefit from inclusion in guidelines as part of the high-risk cohorts who may benefit from regular skin cancer screening, in addition to standard population-based cancer screening for breast, bowel and cervical cancers.”
It concluded that a multidisciplinary approach to the care of Australian CLL patients, with special attention to cancer screening and skin cancer prevention in both the primary care setting and the CLL clinic was important.
The study was supported by Janssen Pharmaceuticals.