IL-23 Inhibitors Appear Safe in Psoriasis With Cancer

Medscape

20-06-2025

TOPLINE:
A study found low rates of cancer recurrence, progression, or new malignancy among patients with psoriasis and prior neoplasia receiving interleukin-23 (IL-23) inhibitors.
METHODOLOGY:
Researchers conducted a retrospective, observational, multicenter study across 16 dermatology centers in Italy, which included 198 adults (39.9% women; mean age, 65.5 years) with moderate-to-severe plaque psoriasis and a personal history of cancer.
Participants were being treated with anti-IL-23 agents (guselkumab, risankizumab, or tildrakizumab); 33.8% had a history of malignancy within the past 5 years, and 66.2% had been diagnosed with cancer before that time.
Primary endpoints were neoplasia progression or recurrence or new neoplastic events, while secondary outcomes evaluated potential risk factors.
TAKEAWAY:
Progression or recurrence of existing neoplasia was reported in six patients (3.0%) during the study period; bladder cancer was the most common (50%), followed by individual cases of breast cancer, leiomyosarcoma, and pleural mesothelioma. No significant difference was seen between the therapies.
Additionally, six patients (3.0%) developed new cancers during IL-23 treatment, including one case each of breast cancer, gastric cancer, cutaneous melanoma, renal cancer, uterine squamous cell carcinoma, and hepatic cholangiocarcinoma, with only two cases leading to treatment discontinuation.
Despite a higher occurrence of new cancer development in patients receiving risankizumab (four patients, 67%) compared with guselkumab (one patient, 17%) and tildrakizumab (one patient, 17%), the difference was not statistically significant.
No significant associations were found between the incidence of neoplastic progression or recurrence, or the development of a new neoplasia, with comorbidities or previous treatments.
IN PRACTICE:
'To the best of our knowledge, our real-life experience is the largest study investigating the use of anti-IL-23 agents and the risk of cancer recurrence, progression, and development in patients with a history of cancer,' the study authors wrote. 'Despite the reassuring data, larger studies are needed to confirm these results.'
SOURCE:
The study was led by Francesca Satolli, Dermatology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy, and was published online on June 16 in the Clinical and Experimental Dermatology.
LIMITATIONS:
Limitations included retrospective design, limited sample size, lack of a control group, and heterogeneity in cancer types and stages.
DISCLOSURES:
Almirall provided support for manuscript writing costs. The authors declared having no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.