ID #265 A PILOT OF A SPECIALISED PAEDIATRIC DERMATO-ONCOLOGY CLINIC FOR CHILDREN ON TARGETED INHIBITOR THERAPY AT GREAT ORMOND STREET HOSPITAL
Katie Green, Polly Outram, Nicole Knoepfel, Darren HargraveAbstract
Introduction
Children with cancer are increasingly treated with molecularly-targeted inhibitors, which, whilst often highly effective, frequently cause dermatological toxicities with quality of life (QOL) impact and/or require dose interruption, reduction or discontinuation. We established a pilot specialised dermatology-oncology skin clinic to evaluate and optimise management of dermatological toxicities experienced by these patients.
Methods
All patients treated with molecularly-targeted inhibitor therapies were invited to attend the pilot dermato-oncology clinic. Data was collected over 6-months, including demographic and clinical data, & patient-reported QOL data from parent and child skin questionnaires, validated dermatology skin toxicity scores, and PedsQL QOL questionnaires. Skin toxicities were assessed using CTCAE V6.0 and validated with a second clinician. Specialist dermatological treatment and management advice was given and recorded, and medical photography performed.
Results
We conducted 18 clinic appointments (15 initial assessments, 3 follow-ups). Patients were receiving Trametinib(5), Tovorafenib(4), Selumetinib(3), combination Dabrafenib/Trametinib(2), or Sorafenib(1). Most patients(8) and parents (11) reported that inhibitor treatment had improved their life overall, especially compared to prior chemotherapy. However, all 15 children reported skin toxicity impacting their lives, with 10 reporting toxicity causing daily problems or preventing activity and hobbies. Six patients required treatment breaks, 6 reported pain, 3 low mood or emotional changes from skin toxicity. Prior treatment of skin toxicity had mixed results, with 50% reporting not benefitting from dermatological supportive care from oncologists.
Observed toxicities included
Dry skin/eczema(11), maculopapular rash(11), erythema(12), pruritis(9), paronychia(7), acneiform rash(7), hair changes(6), alopecia(3), folliculitis(2), and photosensitivity(2). The pilot clinic was well-received, with families willing to travel for the extra clinic, and reporting improved symptom management and QOL scores in follow-up visits.
Conclusion/Implications
Skin toxicity from targeted inhibitor treatment is common, heterogeneous, and potentially detrimental to QOL. Specialist dermatological input benefited supportive skin care, toxicity grading and patient-reported QOL. The piloting of new standardised treatment algorithms for common toxicities is now underway.