Management of myelofibrosis and concomitant advanced cutaneous squamous cell carcinoma with ruxolitinib associated with
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LETTER TO THE EDITOR
Management of myelofibrosis and concomitant advanced cutaneous squamous cell carcinoma with ruxolitinib associated with cemiplimab Alessio Di Prima 1 & Andrea Botticelli 2 & Emilia Scalzulli 1 & Gioia Colafigli 1 & Sara Pepe 1 & Chiara Lisi 1 & Paolo Marchetti 2 & Maurizio Martelli 1 & Robin Foà 1 & Massimo Breccia 1 Received: 14 July 2020 / Accepted: 24 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor Ruxolitinib is an oral target small molecule inhibitor of Janus kinase (JAK) 1 and 2 approved for the treatment of myelofibrosis (MF) and polycythemia vera (PV) patients [1]. A significant improvement in spleen dimension and constitutional symptoms in MF have been reported [2]. Long-term findings from the COMFORT-II study, a phase 3 trial of ruxolitinib versus best available therapy (BAT) for MF, have indicated an increased risk of newly diagnosed non-melanoma skin cancer (basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]) in 17.1% of patient in the ruxolitinib arm and in only 2.7% of patients on the BAT arm [3]. It has been reported that cutaneous malignancies developing in patients on ruxolitinib therapy exhibit a more aggressive and metastatic profile [4–6]. We hereby report a case of combined treatment of cemiplimab and ruxolitinib for a relapsed and advanced non-melanoma skin cancer in a MF patient. In 2009, a 72-year-old man was diagnosed as having a secondary MF in a JAK2-positive PV treated with hydroxyurea for 5 years. In March 2015, due to constitutional symptoms and increased splenomegaly, he started treatment with ruxolitinib, initially at a reduced dose of 5-mg BID because of a baseline anemia. Two years later, considering the improvement in the hemoglobin levels, ruxolitinib was increased to 15 mg daily. A complete control of splenomegaly and resolution of associated symptoms was obtained without the need of transfusion support. After 13 months of ruxolitinib treatment, * Massimo Breccia [email protected] 1
Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto 1, Sapienza University, Via Benevento 6, 00161 Rome, Italy
2
Clinical and Molecular Department, Oncologia B Policlinico Umberto I, Sapienza University, Rome, Italy
the patient presented a BCC on the right temporal region with squamous cell differentiation and well-defined margins that was treated with local surgery. About 2 years later, he reported two new lesions and the pathologic examination revealed an invasive and ulcerated SCC with evident keratinization and well-differentiated lesion on the right jowl (Broder I), while a medium histologic differentiation was detected on the left jowl (Broder II) associated with a Bowen carcinoma (squamous cell carcinoma In situ (SCCS)/Bowen’s Disease). Both lesions showed clear excision borders. During 2019, 4 years after the start of ruxolitinib, the patient developed multiple skin lesions in different regions: right temple, forehead, right and left cheek bones, and nose, treate
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