Mario E. LaCouture, M.D., discovered during his residency that the role of dermatology in cancer patients' lives was much greater than just treating skin cancers. He would watch as breast, lung, colon and other cancer patients would complain about the damage that anticancer treatments - especially the new biologics - were doing to their skin. Patients in phase 1 and 2 clinical trials, who had exhausted their treatment options, were having to forgo life-prolonging treatment because of life-altering cutaneous effects, including itching so severe that they could not function or sleep.
Patients in phase 1 and 2 clinical trials, who had exhausted their treatment options, were having to forgo life-prolonging treatment because of life-altering cutaneous effects, including itching so severe that they could not function or sleep.
"Something had to be done, and dermatologists are the ones to do it," Dr. LaCouture tells Dermatology Times.
New therapies cause more effects
Patients experience skin conditions with traditional cancer treatments, but more so with the new "targeted" therapies, according to Dr. LaCouture.
"These new biologics have favorable side-effect profiles, because they do not cause anemia, bleeding or infection, but they do target proteins that are frequently expressed in skin cells, causing a range of dermatologic side effects, including acne-like rashes of the skin; inflammation around the fingernails, causing separation and tenderness; severely dry or itchy skin; and hair loss and changes in hair color and texture," Dr. LaCouture says.
Moved to action
While training at the University of Chicago (2002-05), Dr. LaCouture discovered that the only options when cutaneous side effects from anticancer treatment became unbearable were to stop potentially lifesaving anticancer therapies.
"The problem is that for many of these patients with advanced cancers, there were no other options in terms of their cancer therapies. Their side effects need to be treated in order for them to survive," Dr. LaCouture says.
With his move to Northwestern in 2005, Dr. LaCouture got the green light in the dermatology department to devote half his day to clinics and half to seeing cancer patients with acute cutaneous effects from treatment, so patients would not have to wait for an appointment.
"For these people, time is a critical factor. Patients cannot wait two weeks to be evaluated. Because of the way we set up the department, I am able to see them very quickly," he says.
Dr. LaCouture and colleagues are validating dermatology-specific quality-of-life questionnaires for cancer patients to help determine how dermatology treatment benefits them.
"We have noticed that after being treated specifically for their dermatologic side effects, patients feel much better in terms of symptoms, as well as their desire to interact with others," he says.
"We also see that by specifically targeting cutaneous side effects and closely watching them, they are less likely to have to modify therapy," Dr. LaCouture says.
Derms should know
Dermatologists, in general, should become familiar with how the new array of anticancer drugs might impact patients' skin.
"With our dermatologic knowledge, we are capable of doing many wonderful things for these patients that many other people cannot. So, by providing patients with rapid access to our clinic to see us, we are helping improve their quality of life and survival," he says.