Omalizumab use in patient with malignancy
Question:
11/12/2019
85 M PMHx of renal cell carcinoma S/P nephrectomy 2016 and pulmonary nodule with negative biopsy but nodule has increased in size. Currently being treated for refractory chronic urticaria with Xolair 300 mg q four weeks, well-controlled. Is there any issues or concerns continuing Xolair in this setting given the history of renal cell cancer and/or increasing pulmonary nodule size? Also, in general, are there any concerns for Xolair administration in patients with a history of cancer?
Answer:
You do not mention if the Xolair was started before or after the renal cell carcinoma appeared. As you know, the EXCELS study and another report looking at pooled data from clinical trials and did not find an association between Xolair and malignancy. Screening for cancer has not been recommended prior to initiating Xolair treatment. There are no warnings about Xolair administration in patients with a history of cancer. In cases such as the one you describe, it is important to have a conversation with the patient about what is and is not known about Xolair and malignancy, to discuss the rationale for its use in this setting, and to monitor the patient closely. Such a discussion will help the patient decide whether or not to agree to Xolair use.
I hope this helps you and your patient.
Jacqueline A. Pongracic, MD, FAAAAI