Dupilumab in cancer patients: A narrative review of cutaneous toxicities, safety considerations, and emerging oncologic insights

Background: With the expanding use of immune checkpoint inhibitors (ICIs), immune-related adverse events are increasingly common, with cutaneous immune-related adverse events (cirAEs) being the most frequent. Dupilumab, an IL-4 receptor α antagonist, has emerged as a potential treatment for cirAEs and other cancer-associated dermatoses, warranting synthesis of its safety and efficacy profile. Objective: To synthesize the current evidence regarding the use of dupilumab in patients with cancer, focusing on its efficacy in managing cancer-related dermatoses and its safety profile in the context of malignancy, including concerns related to cutaneous T-cell lymphoma (CTCL). Methodological approach: A narrative review of the literature was conducted using PubMed. Search terms included “dupilumab in cancer,” “dupilumab,” “malignancy,” and “cancer.” Abstracts were screened for relevance, followed by full-text review of eligible studies. Key findings: Evidence demonstrates dupilumab’s utility in managing diverse dermatoses, including those induced by ICIs, as well as toxicities from epidermal growth factor receptor inhibitors and multiple myeloma therapies. Beyond symptom management, literature has begun exploring dupilumab’s safety in patients with active or prior malignancies. Most retrospective studies report no overall increase in cancer risk, though concerns remain regarding a possible association with CTCL. Case series and observational reports have yielded mixed findings, underscoring the need for prospective research. Additionally, mechanistic studies implicating IL-4 signaling in tumorigenesis have led to clinical trials investigating dupilumab in combination with ICIs for non-small cell lung cancer. Conclusions: Dupilumab appears to be a safe and effective treatment for cancer-related dermatoses, including cirAEs. Nevertheless, its relationship with CTCL remains incompletely understood, highlighting the need for prospective studies.