Apremilast in Patients with a History of Cancer: A Five-Year Clinical Perspective
Managing moderate-to-severe plaque psoriasis and psoriatic arthritis in patients with a history of cancer remains a clinically complex and under-investigated area. Traditional immunosuppressive agents and biologics are often used conservatively in oncology patients with these comorbidities due to potential risks of malignancy recurrence or immune interference. However, real-world data from Lanna et al. suggests that apremilast, a phosphodiesterase 4 (PDE4) inhibitor, may offer a favorable balance between efficacy and oncologic safety.
This retrospective, single-center observational study published in Clinical, Cosmetic and Investigational Dermatology in 2025 followed 79 patients with a confirmed history of cancer within the past five years and a diagnosis of psoriasis and/or psoriatic arthritis. Most patients were female (65 percent), with an average age of 59 years. The most common malignancies included breast cancer (25 percent), prostate cancer (14 percent), melanoma (12.7 percent), colorectal adenocarcinoma (10.1 percent), and bladder carcinoma (10 percent).
Apremilast was initiated two years post-cancer diagnosis on average, with patients undergoing regular clinical and oncological monitoring, including tumor markers and imaging, every six months. Patients were either biologic-naïve or had prior exposure to systemic agents, including methotrexate, cyclosporine, or anti-TNF agents.
Therapeutic Outcomes and Safety Signals
Apremilast significantly improved dermatologic and articular symptoms. The mean Psoriasis Area Severity Index (PASI) decreased from 8.3 at baseline, with significant improvement observed by week 52 and sustained through year five. Dermatology Life Quality Index (DLQI) scores improved in parallel with PASI reductions, while pain visual analog scores (PAIN VAS) for psoriatic arthritis showed a significant decrease by week 78, with effects sustained throughout the five-year follow-up.
Notably, no patients experienced recurrence or progression of malignancy over the five-year treatment period. Tumor markers remained stable, and imaging revealed no suspicious changes, strongly suggesting a non-interfering oncologic safety profile.
Apremilast was well tolerated, with mild adverse events limited to transient diarrhea (11 percent) and asthenia (1 percent). No serious adverse events were reported, and no patients discontinued therapy due to side effects.
While biologic agents targeting IL-17 and IL-23 have shown safety in cancer survivors, concerns remain around their direct cytokine blockade and possible effects on tumor immune surveillance. Apremilast’s upstream modulation of inflammatory pathways, via cAMP regulation, may offer an immunologically safer route by reducing multiple cytokines without fully suppressing any single immune axis.
Clinical Implications
For dermatologists and rheumatologists managing psoriatic disease in patients with a recent history of cancer, apremilast offers a promising alternative that balances therapeutic efficacy with oncologic caution. For oncologists, these findings support closer collaboration with dermatology to help ensure this population is not under-treated due to concerns about recurrence. Further prospective, controlled studies, ideally with comparator arms involving newer biologics, will be essential to solidify these findings.
Reference:
- Lanna C, Rivieccio A, Vultaggio M, et al. Efficacy and safety of apremilast in oncological patients with moderate-to-severe plaque psoriasis: A 5 years retrospective observational study. Clinical, Cosmetic and Investigational Dermatology. 2025;18:1231-1238. doi:10.2147/CCID.S499658