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Cancer-related Pruritus — SCE Medical Oncology MCQ

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ModerateSupportive & Palliative OncologyCancer-related PruritusSCE Medical Oncology

A 55-year-old man with advanced cancer develops pruritus without visible skin disease. He has no liver or renal impairment. What is the most likely mechanism and first-line treatment?

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Correct answer: E — Cancer-related generalised pruritus (paraneoplastic or treatment-related) — first-line treatment is emollients + gabapentin/pregabalin or low-dose mirtazapine; investigation for underlying lymphoma (especially Hodgkin) should be considered

Generalised pruritus without primary skin disease (pruritus sine materia) in cancer patients can be paraneoplastic (especially Hodgkin lymphoma, cutaneous T-cell lymphoma, polycythaemia vera), treatment-related (opioids, targeted therapy), or related to cholestasis. After excluding treatable causes, pharmacological management includes: gabapentin/pregabalin (first-line for cancer-related pruritus), mirtazapine (5-HT3 antagonism), aprepitant (for refractory cases), and naloxone/naltrexone for opioid-induced pruritus. Topical emollients and avoiding skin irritants are foundational.

Reference: ESMO 2024 Supportive Care; NICE Palliative Care; Zirwas et al JAAD 2017