BI07 (P086) Management of severe psoriasis in patients with concomitant malignancy: a retrospective observational study

Abstract Biologic therapies have revolutionized the management of psoriasis, with well-documented efficacy and safety in clinical trials and real-life studies. While biologics have not been associated with an increased risk in malignancy, data on their use in patients with recent diagnosis of malignancy are limited. We conducted a retrospective observational study at a tertiary dermatology centre, reviewing the management of severe psoriasis in patients with concomitant malignancy from November 2019 to December 2024. In total, 49 patients were included, with a mean age of 62 years. Data collected included patient demographics, psoriasis subtype, Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), cancer type, concurrent psoriasis, and cancer treatments and subsequent treatment outcomes. The cohort consisted of 17 men and 32 women. The most common psoriasis subtype was plaque psoriasis. At cancer diagnosis the mean PASI was 10 and the mean DLQI was 13. The most frequent cancers were breast cancers (11 of 49, 22%), non-Hodgkin lymphomas (five of 49, 10%), colon cancers (five of 40, 10%) and rectal cancers (four of 49, 8%). Prior psoriasis treatments included ultraviolet B phototherapy, methotrexate, ciclosporin and acitretin. At cancer diagnosis, 10 patients (20%) were on tumour necrosis factor (TNF)-α inhibitors, eight (16%) on interleukin (IL)-17 inhibitors, five (10%) on IL-12/23 inhibitors, five (10%) on IL-23 inhibitors, six (12%) on methotrexate, two (4%) on apremilast and one (2%) on ciclosporin. Three patients (6%) were on a combination therapies. Multidisciplinary discussions regarding biologic use were documented in 39 patients (80%). Most treatments were discontinued during cancer therapy, although nine patients (18%) continued biologics (two TNF-a inhibitors, three IL-17 inhibitors, one IL-23 inhibitors, two apremilast and one methotrexate). Psoriasis was generally stable during chemotherapy but often flared post-treatment. Following treatment for underlying malignancy, biologic therapies were commenced in 20 patients (41%), with five (10%) receiving TNF-a inhibitors, six (12%) IL-17 inhibitors, two (4%) IL-12/23 inhibitors and seven (14%) IL-23 inhibitors. Nine patients (18%) died due to cancer progression and five patients (10%) developed recurrent or new malignancies while on biologics. Follow-up intervals varied from 3 monthly to 6 monthly, with some requiring frequent reviews due to psoriasis flares. This study highlights the importance of an individualized approach to managing psoriasis in patients with malignancy. Biologic therapies are effective and relatively safe, allowing control of severe psoriasis without compromising cancer care. Multidisciplinary collaboration and shared decision making are essential. Clinicians should consider biologic therapies for patients with both malignancy and uncontrolled psoriasis, tailoring treatments to patient-specific factors and malignancy type.