Pigmentary changes in patients treated with targeted anticancer agents: A systematic review and meta-analysis

Background The discovery of signaling networks that drive oncogenic processes has led to the development of targeted anticancer agents. The burden of pigmentary adverse events from these drugs is unknown. Objective To conduct a systematic review and meta-analysis of published clinical trials and determine the incidence and risk of development of targeted therapy–induced pigmentary changes. Methods A comprehensive search was conducted to identify studies reporting targeted therapy–induced pigmentary changes. The incidence and relative risk were calculated. Case reports and series were reviewed to understand clinical characteristics. Results A total of 8052 patients from 36 clinical trials were included. The calculated overall incidences of targeted cancer therapy–induced all-grade pigmentary changes in the skin and hair were 17.7% (95% confidence interval [CI], 11.9-25.4) and 21.5% (95% CI, 14.9-30.1), respectively. The relative risk of all-grade pigmentary changes of skin and hair were 93.7 (95% CI, 5.86-1497.164) and 20.1 (95% CI, 8.35-48.248). Across 53 case reports/series (N = 75 patients), epidermal growth factor receptor and breakpoint cluster region–abelson inhibitors were the most common offending agents. Limitations Potential under-reporting and variability in oncologists reporting these events. Conclusion There is a significant risk of development of pigmentary changes during treatment with targeted anticancer therapies. Appropriate counseling and management are critical to minimize psychosocial impairment and deterioration in quality of life.