Toxicity of Treatment for Histiocytic Neoplasms

Ronald S. Go, MD, a hematology oncologist with the Mayo Clinic, explains how toxicities of treatment for histiocytic neoplasms compared with toxicities observed in other malignancies.

In the National Comprehensive Cancer Network Clinical Practice Guidelines version 2.2021 for histiocytic neoplasms, different adverse events occur with standard systemic therapy versus targeted therapy. With standard chemotherapy, most toxicities are low grade, but grade 3/4 AEs were seen in 20% of patients on cytarabine, 37% on cladribine, and 75% of those who received the combination of vinblastine and prednisone in previous studies.

With targeted therapies, the grade ¾ AEs observed in patients with histiocytic neoplasms who received vemurafenib (Zelboraf), included hypertension (27%), maculopapular rash (23%), increased lipase (15%), arthralgia (12%), hyperkeratosis (8%), and actinic keratosis (8%). With cobimetinib (Cotellic), there were AEs that led to a significant number of dose reductions, including, ejection fraction decrease (27.8%), rash (11.1%), and diarrhea (11.1%)

The guidelines also compare the AEs observed in patients with histiocytic neoplasm to patients with melanoma treated with the same drugs. The safety findings were similar, but in some cases, patients with histiocytic neoplasm had higher toxicity rates. For example, skin-related adverse events were higher in histiocytic neoplasms than previously observed in patients with metastatic melanoma.

Transcription:

0:07 | All of these drugs that are used in histiocytic neoplasms are drugs that are used in the other more common cancers. The chemotherapy agents that we use are commonly used in other hematologic cancers. For the targeted agents, they're commonly used in melanoma. And therefore, we did not focus or write a new section on toxicity management, we did refer the readers to the excellent toxicity management sections in the other guidelines, say for example, in melanoma, and in other malignancies.

_Reference:

_{Go RS, Jacobsen E, Baocchi R, et al. Histiocytic Neoplasms, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19(11): 1277-1303. doi: 10.6004/jnccn.2021.0053.}