News in brief: Oncologist alleges discrimination by palliative care service; Skin reactions with checkpoint inhibitors; Polygenic risk score for melanoma

Oncologist accuses palliative care service of ‘abhorrent’ discrimination

Cancer patients who choose to die at home under Victoria’s voluntary assisted dying laws are being shunned by Catholic Church-aligned palliative care services, an oncologist says.

Dr Cameron McLaren said it was ‘abhorrent’ that healthcare staff working for Eastern Palliative Care were not permitted to attend the homes of patients to verify the cause of death if the patient had died under the laws introduced in the state two years ago. Dr McLaren told The Age the refusal was discriminatory and unethical, causing shame and stigma for the families of the patients. There were also reports of pharmacists being denied entry to palliative care clinics if they were believed to have medications used for assisted dying, he said.

Common skin reactions with checkpoint inhibitors

A clearer picture of the frequency and range of cutaneous immune related adverse events (irAEs) associated with immune checkpoint inhibitors has been provided by a US study.

Analysis of data from 8,637 cancer patients checkpoint inhibitors showed that the overall incidence of skin-related side effects was 25.1%, with a median time of onset of 113 days.

The most frequent cutanaeous adverse events included pruritus, mucositis, erythroderma, maculopapular eruption, vitiligo, lichen planus, bullous pemphigoid, Grover’s disease, rash and other non-specific eruption.

The risk of cutaneous irAEs was highest in patients with melanoma and renal cell carcinoma, and those receiving combination therapy.

The study investigators said that only 10 of more than 40 skin conditions previously linked to immune checkpoint inhibitors were actually seen at a high incidence among cancer patients taking the medications.

They also found that 5% of patients were prescribed systemic corticosteroids to treat cutaneous irAEs, despite concerns that they may blunt the anti-tumour effects of immunotherapy.

The findings are published in the Journal of the American Academy of Dermatology.

 Genomic score reveals risk of melanoma

A polygenic risk score is associated with melanoma risk in older people and may help to target surveillance, findings from an Australian-led study suggest.

Researchers at Monash University assessed polygenic risk scores (PRS) for 55 melanoma gene variants in people over 75 taking part in the five year ASPREE trial of low dose aspirin.

During follow up they found that 1% of patients developed melanoma and PRS was associated with risk of developing incident melanoma (Hazard Ratio 1.55). Participants in the highest risk PRS group had a higher risk (HR 2.51) than those with the lowest risk group. After adjusting for sex, only males had a significant association between PRS and incident melanoma, according to findings published in the Journal of the National Cancer Institute.

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