Gavini Divya R, Salvi Dhairya J, Shah Prutha H, Uma Davuluri, Lee Jun Hee, Hamid Pousette
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2021 Aug 7;13(8):e16978. doi: 10.7759/cureus.16978. eCollection 2021 Aug.
Hydroxyurea (HU) or hydroxycarbamide is a cytotoxic antimetabolite widely used to treat Philadelphia chromosome-negative Myeloproliferative Neoplasms (Ph-MPN) like Polycythemia Vera (PV), Essential Thrombocythemia (ET), and Primary Myelofibrosis (PMF). Patients with Ph-MPN are at an increased risk of Non-melanoma skin cancers (NMSC). The cause of this finding remains uncertain. In this systematic review, we would like to know if chronic use of HU in this population is responsible for the sudden onset of NMSC. The results obtained will help the patients and clinicians with early diagnosis of cutaneous lesions and in optimizing the current treatment options for MPN. We conducted a multi-database literature search, applied eligibility criteria and quality assessment tools to the studies extracted, with an intention to include only fair to high-quality articles. We analyzed six observational studies and four traditional reviews. Two out of 10 studies concluded that no relationship exists between the incidence of NMSC and HU. The remaining eight studies indicated the association. According to these studies, the possible risk factors include old age, excessive exposure to sunlight, higher doses, and prolonged HU therapy duration. Ultraviolet (UV) radiation and HU play a combined role in carcinogenesis. Periodic dermatologic screening is essential in these patients. Prompt biopsy and accurate diagnosis can prevent the progression of cancer and decrease the associated morbidity and mortality. True incidence and causation cannot be ascertained due to the scarcity of research on this topic. Multi-center prospective studies in large groups of Ph-MPN patients are recommended to determine the temporal relationship between NMSC and HU treatment.
羟基脲（HU）或羟基尿素是一种细胞毒性抗代谢物，广泛用于治疗费城染色体阴性骨髓增殖性肿瘤（Ph-MPN），如真性红细胞增多症（PV）、原发性血小板增多症（ET）和原发性骨髓纤维化（PMF）。Ph-MPN患者患非黑色素瘤皮肤癌（NMSC）的风险增加。这一发现的原因尚不确定。在本系统评价中，我们想了解在该人群中长期使用HU是否是NMSC突然发病的原因。所获得的结果将有助于患者和临床医生早期诊断皮肤病变，并优化目前MPN的治疗方案。我们进行了多数据库文献检索，对提取的研究应用了纳入标准和质量评估工具，旨在仅纳入质量为中等至高质量的文章。我们分析了六项观察性研究和四项传统综述。10项研究中有两项得出结论，NMSC的发病率与HU之间不存在关联。其余八项研究表明存在关联。根据这些研究，可能的风险因素包括老年、过度暴露于阳光下、更高剂量以及更长的HU治疗持续时间。紫外线（UV）辐射和HU在致癌过程中起联合作用。对这些患者进行定期皮肤科筛查至关重要。及时活检和准确诊断可以预防癌症进展，并降低相关的发病率和死亡率。由于关于该主题的研究较少，无法确定真实发病率和因果关系。建议在大量Ph-MPN患者中进行多中心前瞻性研究，以确定NMSC与HU治疗之间的时间关系。
