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A patient doing well on an IL-17 inhibitor is diagnosed with cancer, and the oncologist wants the biologic stopped. It is a call most dermatologists have made without much to stand on: patients with cancer are excluded from psoriasis trials, so the entire evidence base is observational. A new IPC paper in JAAD Reviews takes a position anyway. Per the summary of product characteristics, active malignancy is not a contraindication to any biologic. IL-17 and IL-23p19 inhibitors are first-line, TNF inhibitors and deucravacitinib warrant caution, and cyclosporine is the one to avoid outright. The authors also warn that psoriasis severity is routinely underestimated once a patient is in oncology care: if they meet IPC’s criteria, they are a candidate for systemic therapy regardless of what else is on their problem list. “Too often, systemic psoriasis therapy is discontinued or never initiated in patients with cancer, even when the evidence supports safe and effective options,” says Paolo Gisondi, MD, IPC Councilor and lead author. The post includes the therapeutic options figure, designed as a reference for both specialties to work from, and a slide set for teaching and presentations.

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