1
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Plachouri KM, Florou V, Georgiou V, Georgiou S. Cutaneous Side Effects of Modern Targeted Therapy and Immunotherapy in Patients with Dermatological Malignancies. Cancers (Basel) 2023; 15:3126. [PMID: 37370736 DOI: 10.3390/cancers15123126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
The advent of immunotherapy and targeted therapies in treating dermatological malignancies has dramatically changed the landscape of dermato-oncology in recent years. Their superior efficacy compared to previous therapeutic options, such as chemotherapy, has resulted in their use in treating devastating malignancies, such as melanoma or unresectable/metastatic basal cell and squamous cell carcinoma. Skin toxicity is a critical safety consideration, among other adverse reactions, that can occur under treatment with these agents. This article aims to summarize the cutaneous side effects of immune checkpoint inhibitors and targeted dermato-oncological therapies. Although the skin side effects of these agents are primarily mild, they can occasionally affect the decision for treatment continuation and the quality of life of the affected patients. Therefore, physicians must be acquainted with the specific cutaneous toxicity profile of such treatments to mitigate their impact on the patients and optimize the overall outcome of dermato-oncological therapy.
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Affiliation(s)
- Kerasia-Maria Plachouri
- Dermatology Department, University General Hospital of Patras, University of Patras, 265 04 Rio, Greece
| | - Vaia Florou
- Division of Oncology, Department of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 841112, USA
| | - Vasileios Georgiou
- School of Medicine, University General Hospital of Patras, University of Patras, 265 04 Rio, Greece
| | - Sophia Georgiou
- Dermatology Department, University General Hospital of Patras, University of Patras, 265 04 Rio, Greece
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2
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Bala VM, Mitsogianni M, Laschos K, Pliakou E, Lazaridi E, Lampropoulou DI, Aravantinos G. Mediastinal and hilar sarcoid‑like reaction in a patient treated with dabrafenib and trametinib for metastatic melanoma: A case report and review of the literature. Mol Clin Oncol 2022; 16:99. [DOI: 10.3892/mco.2022.2532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/04/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Vanessa-Meletia Bala
- 2nd Department of Medical Oncology, General Oncology Hospital of Kifissia ‘Agioi Anargyroi’, Athens 145 64, Greece
| | - Maria Mitsogianni
- 2nd Department of Medical Oncology, General Oncology Hospital of Kifissia ‘Agioi Anargyroi’, Athens 145 64, Greece
| | - Konstantinos Laschos
- 2nd Department of Medical Oncology, General Oncology Hospital of Kifissia ‘Agioi Anargyroi’, Athens 145 64, Greece
| | - Evangelia Pliakou
- 2nd Department of Medical Oncology, General Oncology Hospital of Kifissia ‘Agioi Anargyroi’, Athens 145 64, Greece
| | - Eirini Lazaridi
- 2nd Department of Medical Oncology, General Oncology Hospital of Kifissia ‘Agioi Anargyroi’, Athens 145 64, Greece
| | - Dimitra-Ioanna Lampropoulou
- 2nd Department of Medical Oncology, General Oncology Hospital of Kifissia ‘Agioi Anargyroi’, Athens 145 64, Greece
| | - Gerasimos Aravantinos
- 2nd Department of Medical Oncology, General Oncology Hospital of Kifissia ‘Agioi Anargyroi’, Athens 145 64, Greece
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3
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Pham JP, Star P, Phan K, Loh Y, Joshua AM, Smith A. Review BRAF inhibition and the spectrum of granulomatous reactions. J Am Acad Dermatol 2021; 87:605-613. [PMID: 34715287 DOI: 10.1016/j.jaad.2021.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 12/01/2022]
Abstract
BRAF-inhibitors have emerged as a promising targeted therapy for malignancies with BRAF mutations, particularly metastatic melanoma. However, granulomatous reactions including sarcoidosis and sarcoid-like-reactions have been reported as a consequence of BRAF-inhibition. It is important to adequately characterise these granulomatous reactions including cutaneous manifestations and systemic involvement, in order to guide investigations and management. A literature review was conducted to characterise the spectrum of granulomatous reactions associated with BRAF-inhibitors - identifying 55 reactions affecting 51 patients, with 37 reactions limited to cutaneous involvement. Further, possible correlation with cancer response, mechanisms of granuloma formation, as well as a proposed workup and management approach for these granulomatous reactions are presented.
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Affiliation(s)
- James P Pham
- St. Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Phoebe Star
- St. Vincent's Hospital, Sydney, NSW, Australia
| | - Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia
| | - Yanni Loh
- St. Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Anthony M Joshua
- St. Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia; Melanoma Institute of Australia, North Sydney, NSW, Australia; Medical Oncology, The Kinghorn Cancer Centre, Sydney, NSW, Australia
| | - Annika Smith
- St. Vincent's Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia; Melanoma Institute of Australia, North Sydney, NSW, Australia; The Mater Hospital, North Sydney, NSW, Australia
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4
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Anastasopoulou A, Diamantopoulos PT, Skalioti C, Liapis G, Psychogiou E, Ziogas DC, Gogas H. The diagnosis and management of sarcoid-like reactions in patients with melanoma treated with BRAF and MEK inhibitors. A case series and review of the literature. Ther Adv Med Oncol 2021; 13:17588359211047349. [PMID: 34691245 PMCID: PMC8532252 DOI: 10.1177/17588359211047349] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/01/2021] [Indexed: 12/18/2022] Open
Abstract
Sarcoidosis and sarcoid-like reactions (SLR) have been repeatedly reported in patients with melanoma treated with BRAF and MEK inhibitors. In the current study we present three patients that developed SLR under treatment with BRAF and mitogen-activated protein kinase (MEK) inhibitors for melanoma. Two patients developed mediastinal lymphadenitis with histological features of an SLR while on targeted therapy in the adjuvant setting, whereas one patient with metastatic melanoma developed granulomatous nephritis while receiving combination treatment with BRAF/MEK inhibitors and atezolizumab. In addition, we review the published literature on the pathogenesis, clinical characteristics, histologic features, imaging findings, and other potential useful diagnostic tools. We also address the need for a common terminology for these cases and propose an algorithm for the accurate diagnosis of BRAF/MEK inhibitor-induced SLR. We also review the currently available data on the treatment of these patients and suggest a treatment approach for SLR in patients with melanoma, as well as for the management of melanoma when SLR emerges.
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Affiliation(s)
- Amalia Anastasopoulou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Greece
| | - Panagiotis T. Diamantopoulos
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, 17 Agiou Thoma street, Athens, 11527, Greece
| | - Chrysanthi Skalioti
- Clinic of Nephrology and Renal Transplantation, Laikon General Hospital, Athens, Greece
| | - George Liapis
- First Department of Pathology, Laikon General Hospital, National and Kapodistrian University of Athens, Greece
| | - Eleni Psychogiou
- Pathology Department, Sotiria Regional Chest Disease Hospital of Athens, Greece
| | - Dimitrios C. Ziogas
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Greece
| | - Helen Gogas
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Greece
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5
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Abstract
PURPOSE OF REVIEW BRAF/MEK inhibitor has changed the treatment landscape in patients with advanced and metastatic melanoma with prolonged overall survival and progression-free survival. Since three treatment combinations exist with similar efficacy therapy decisions are often made based on the side effect profile. Additionally, on-target side effects or class effects have to be properly managed to ensure treatment adherence. RECENT FINDINGS Sequential treatment with BRAF/MEK inhibition and immunotherapy might increase toxicity with a sepsis-like syndrome and triple therapy with concomitant BRAF/MEK inhibition and anti-PD1/PD-L1 antibody therapy induces severe side effects in the vast majority of patients. SUMMARY Toxicity of combination therapy with BRAF/MEK inhibitors is generally manageable, reversible and infrequently associated with treatment discontinuation. In case of persisting off-target effects the change to another combination therapy can resolve side effects.
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Affiliation(s)
- Alvaro Moreira
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai
- The Kimberly and Eric J. Waldman Department of Dermatology at Mount Sinai, New York, NY, USA
| | - Céleste Lebbé
- Université de Paris, AP-HP Dermatology, INSERM U976, Saint Louis Hospital, Paris, France
| | - Lucie Heinzerling
- Department of Dermatology, Universitätsklinikum München (LMU), Munich, Germany
- Department of Dermatology, Universitätsklinikum Erlangen, Germany and Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
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6
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Narula N, Iannuzzi M. Sarcoidosis: Pitfalls and Challenging Mimickers. Front Med (Lausanne) 2021; 7:594275. [PMID: 33505980 PMCID: PMC7829200 DOI: 10.3389/fmed.2020.594275] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis, a systemic granulomatous disease of unknown etiology, may mimic other conditions at presentation often resulting in delayed diagnosis. These conditions include infections, neoplasms, autoimmune, cardiovascular, and drug-induced diseases. This review highlights the most common sarcoidosis mimics that often lead to pitfalls in diagnosis and delay in appropriate treatment. Prior to invasive testing and initiating immunosuppressants (commonly corticosteroids), it is important to exclude sarcoid mimickers.
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Affiliation(s)
- Naureen Narula
- Staten Island University Hospital, New York, NY, United States
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7
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Abstract
BACKGROUND Granulomatous drug eruptions are rare entities, where granuloma formation occurs as an attempt to contain an exogenous or endogenous inciting agent. Granulomatous drug eruptions may be localized to the skin or may include major systemic involvement, and their characteristics depend both on the properties of the causative irritant and host factors. Because of the overlapping features amongst noninfectious granulomatous diseases, granulomatous drug eruptions are challenging to diagnose and distinguish both histologically and clinically. OBJECTIVE The objective of this article is to provide a review and summary of the current literature on the five major types of cutaneous granulomatous drug eruptions: interstitial granulomatous drug reaction, drug-induced accelerated rheumatoid nodulosis, drug-induced granuloma annulare, drug-induced sarcoidosis, and miscellaneous presentations. METHODS A systematic review was conducted through PubMed using the search terms "granulomatous drug eruption" and "cutaneous" or "skin". English full-text studies that included human subjects experiencing a cutaneous reaction comprising granulomatous inflammation as the direct result of a drug were included. Of 205 studies identified, 48 articles were selected after a full-text review. Evidence was evaluated using the Tool for evaluating the methodological quality of case reports and case series. RESULTS Polypharmacy and a prolonged lag period from drug ingestion to rash onset may create diagnostic challenges. Ruling out tuberculosis is imperative in the endemic setting, particularly where anti-tumor necrosis factor therapy is the presumed cause. Interstitial granulomatous drug reactions and granuloma annulare are often localized to the skin whereas accelerated rheumatoid nodulosis and sarcoidosis may sometimes be associated with systemic features as well. Granulomatous drug eruptions typically resolve on discontinuing the offending medication; however, the decision for drug cessation is dependent on a risk-benefit assessment. In some situations, supplementation of an additional agent to suppress the reaction may resolve symptoms. In some cases, granulomatous drug eruptions may be pivotal in the successful outcome of the drug, as in cases of melanoma treatment. In all situations, the decision to continue or withdraw the drug should be carefully based on the severity of the eruption, necessity of continuing the drug, and availability of a suitable alternative. CONCLUSIONS Granulomatous drug eruptions should always be considered in the differential diagnosis of noninfectious granulomatous diseases of the skin. Further research examining dose-response relationships and the recurrence of granulomatous drug eruptions on the rechallenge of offending agents is required. Increased awareness of granulomatous drug eruption types is important, especially with continuous development of new anti-cancer agents that may induce these reactions. CLINICAL TRIAL REGISTRATION PROSPERO registration number CRD42020157009.
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Ortiz‐Brugués A, Bosch‐Amate X, Vargas‐Mora P, Gómez S, Giavedoni P, Carrera C. Dermal fillers may induce late‐onset adverse skin reactions in patients under BRAF inhibitors. J Eur Acad Dermatol Venereol 2020; 34:e732-e734. [DOI: 10.1111/jdv.16550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. Ortiz‐Brugués
- Dermatology Department Hospital Clínic University of Barcelona Barcelona Spain
| | - X. Bosch‐Amate
- Dermatology Department Hospital Clínic University of Barcelona Barcelona Spain
| | - P. Vargas‐Mora
- Dermatology Department Hospital Clínic University of Barcelona Barcelona Spain
- Dermatology Department Faculty of Medicine Universidad de Chile Santiago Chile
| | - S. Gómez
- Dermatology Department Hospital Clínic University of Barcelona Barcelona Spain
| | - P. Giavedoni
- Dermatology Department Hospital Clínic University of Barcelona Barcelona Spain
| | - C. Carrera
- Dermatology Department Hospital Clínic University of Barcelona Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras CIBERERInstituto de Salud Carlos III Barcelona Spain
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9
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Rubio-Rivas M, Moreira C, Marcoval J. Sarcoidosis related to checkpoint and BRAF/MEK inhibitors in melanoma. Autoimmun Rev 2020; 19:102587. [DOI: 10.1016/j.autrev.2020.102587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/01/2020] [Indexed: 12/11/2022]
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10
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Huynh S, Lheure C, Franck N, Goldman-Lévy G, Aractingi S, Dupin N, Kramkimel N, Guégan S. Induced sarcoid-like reactions in patients with metastatic melanoma treated with dabrafenib and trametinib: a monocentric retrospective study. Melanoma Res 2020; 30:317-320. [PMID: 32053122 DOI: 10.1097/cmr.0000000000000649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Combined BRAF and MEK inhibition is one of the first-line treatment strategies for patients with advanced BRAF-mutant melanoma. Sarcoid-like reactions (SLRs) have occasionally been described with melanoma systemic treatments such as immunotherapy or the BRAF inhibitor vemurafenib, but very few cases have been reported with dabrafenib and trametinib. Our aim was to better characterize SLR induced by this combination. We conducted a monocentric retrospective observational study among patients treated with dabrafenib and trametinib for BRAF-mutant advanced melanoma from January 2015 to March 2019. Patients presenting with histologically proven SLR were included. We also searched Medline database for all reported cases of SLR induced by targeted therapy. Of 63 patients on dabrafenib/trametinib combination, seven were diagnosed with a SLR. They all had specific cutaneous involvement, and one also displayed mediastinal and salivary glands involvement. None required systemic corticosteroids or dabrafenib/trametinib discontinuation. Three of them (43%) reached melanoma complete remission and are still on targeted therapy; and four patients progressed and died. A literature review yielded 22 additional cases of SLR induced by targeted therapy: the main affected organ was the skin, 11 patients (50%) had systemic involvement, five patients (23%) required systemic corticosteroids to reach partial or complete remission of SLR, 12 (55%) reached partial or complete response of melanoma while six (27%) progressed. BRAF and MEK inhibitors are potential triggers of SLR, although pathological mechanisms remain unclear. The mainstay of treatment is systemic or topical corticotherapy; targeted therapy discontinuation is usually not necessary.
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Affiliation(s)
- Sandra Huynh
- Department of Dermatology, Hôpital Cochin, AP-HP
| | - Coralie Lheure
- Department of Dermatology, Hôpital Cochin, AP-HP
- Paris Descartes University
| | | | | | - Selim Aractingi
- Department of Dermatology, Hôpital Cochin, AP-HP
- Paris Descartes University
- Cochin Institute, Inserm, Paris, France
| | - Nicolas Dupin
- Department of Dermatology, Hôpital Cochin, AP-HP
- Paris Descartes University
- Cochin Institute, Inserm, Paris, France
| | | | - Sarah Guégan
- Department of Dermatology, Hôpital Cochin, AP-HP
- Paris Descartes University
- Cochin Institute, Inserm, Paris, France
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11
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Hypersensibilité retardée aux tatouages induite par un traitement combiné anti-BRAF/anti-MEK. Ann Dermatol Venereol 2019; 146:725-729. [DOI: 10.1016/j.annder.2019.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/07/2019] [Accepted: 08/21/2019] [Indexed: 01/28/2023]
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12
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Abstract
Cutaneous toxicities associated with BRAF inhibitor treatment in patients with metastatic melanoma have been well described. We present a rare association of granulomatous dermatitis in association with the BRAF inhibitor vemurafenib. Three patients with metastatic melanoma all presented with asymptomatic papular eruptions 8-21 months into vemurafenib therapy. Skin biopsies confirmed the diagnosis of granulomatous dermatitis. Other causes of granulomatous dermatitis including infectious agents and sarcoid were excluded. Treatment with potent topical and oral steroids improved the eruptions, but only after the cessation of vemurafenib did all 3 cases of granulomatous dermatitis completely resolve within 2 weeks. It is important to recognize that this association, unlike most other BRAF inhibitor-related skin toxicities, can occur many months after commencement of therapy and that vemurafenib treatment can be continued without clinically significant adverse effects.
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13
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Amoura A, Haroche J, Emile J, Barete S, Helias‐Rodzewicz Z, Charlotte F, Maisonobe T, Amoura Z, Cohen Aubart F. Sarcoidosis occurring during
BRAF
/
MEK
inhibitors is associated with paradoxical
ERK
activation in Erdheim‐Chester patients. J Eur Acad Dermatol Venereol 2019; 33:e348-e350. [DOI: 10.1111/jdv.15636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. Amoura
- Service de Médecine Interne 2 Hôpital de la Pitié‐Salpêtrière Assistance Publique‐Hôpitaux de Paris Centre National de Référence Maladies Systémiques Rares, Lupus Systémique, Syndrome des Anticorps Antiphospholipides et Histiocytoses Sorbonne Université Paris France
| | - J. Haroche
- Service de Médecine Interne 2 Hôpital de la Pitié‐Salpêtrière Assistance Publique‐Hôpitaux de Paris Centre National de Référence Maladies Systémiques Rares, Lupus Systémique, Syndrome des Anticorps Antiphospholipides et Histiocytoses Sorbonne Université Paris France
| | - J.‐F. Emile
- Département de Pathologie EA4340 Hôpital Ambroise Paré Assistance Publique Hôpitaux de Paris Université Versailles‐Saint Quentin BoulogneFrance
| | - S. Barete
- Unité Fonctionnelle de Dermatologie Hôpital de la Pitié‐Salpêtrière Assistance Publique‐Hôpitaux de Paris Sorbonne Université Paris France
| | - Z. Helias‐Rodzewicz
- Département de Pathologie EA4340 Hôpital Ambroise Paré Assistance Publique Hôpitaux de Paris Université Versailles‐Saint Quentin BoulogneFrance
| | - F. Charlotte
- Service d'Anatomie Pathologique Hôpital de la Pitié‐Salpêtrière Assistance Publique‐Hôpitaux de Paris Sorbonne Université Paris France
| | - T. Maisonobe
- Département de Neurophysiologie Hôpital de la Pitié‐Salpêtrière Assistance Publique‐Hôpitaux de Paris Sorbonne Université Paris France
| | - Z. Amoura
- Service de Médecine Interne 2 Hôpital de la Pitié‐Salpêtrière Assistance Publique‐Hôpitaux de Paris Centre National de Référence Maladies Systémiques Rares, Lupus Systémique, Syndrome des Anticorps Antiphospholipides et Histiocytoses Sorbonne Université Paris France
| | - F. Cohen Aubart
- Service de Médecine Interne 2 Hôpital de la Pitié‐Salpêtrière Assistance Publique‐Hôpitaux de Paris Centre National de Référence Maladies Systémiques Rares, Lupus Systémique, Syndrome des Anticorps Antiphospholipides et Histiocytoses Sorbonne Université Paris France
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14
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Giet G, Lebas E, Rorive A, Arrese JE, Nikkels AF. Granulomatous Reactions from Tattoos Following BRAF Inhibitor Therapy. Case Rep Dermatol 2019; 11:101-107. [PMID: 31123453 PMCID: PMC6514520 DOI: 10.1159/000499959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/28/2019] [Indexed: 01/17/2023] Open
Abstract
BRAF inhibitors may present several cutaneous adverse effects, including actinic keratosis, squamous cell carcinoma, keratoacanthoma, rashes, increased photosensitivity, panniculitis, palmoplantar and capillary involvement, pruritus and xerosis as well as granulomatous reactions. A 30-year-old patient with multiple tattoos received dabrafenib and trametinib for metastatic melanoma. After 4 months, he developed an induration and thickening strictly limited to several tattoos. Histopathology revealed nonnecrotizing granulomas in the dermis. Topical steroids relieved pruritus but not the granulomatous aspect of the tattoos. As far as we know, this is the first description of granulomatous reactions restricted to preexisting tattoos following BRAF inhibitor therapy.
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Affiliation(s)
- Gabrielle Giet
- Department of Dermatology, Liège University Hospital, CHU du Sart Tilman, Liège, Belgium
| | - Eve Lebas
- Department of Dermatology, Liège University Hospital, CHU du Sart Tilman, Liège, Belgium
| | - Andrée Rorive
- Department of Medical Oncology, Liège University Hospital, CHU du Sart Tilman, Liège, Belgium
| | - Jorge E Arrese
- Department of Dermatopathology, Liège University Hospital, CHU du Sart Tilman, Liège, Belgium
| | - Arjen F Nikkels
- Department of Dermatology, Liège University Hospital, CHU du Sart Tilman, Liège, Belgium
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15
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Abstract
The development of cancer immunotherapy and targeted therapy has reached an important inflection point in the history of melanoma. Immune checkpoint inhibitors and kinase inhibitors are today's standard of care treatments in advanced melanoma patients. Treatment-related toxicities can be very intriguing and quite challenging. Sarcoidosis is a multisystemic granulomatous disease characterized by an aberrant immune response to unknown antigens, whereas sarcoid-like reactions (SLRs) refer to localized clinical features. We carried out a single-center observational study in patients with stage IIB-IV melanoma treated with BRAF/MEK inhibitors and immune checkpoint inhibitors. A description of the sarcoidosis-related manifestations was provided from patients' records. We observated eight cases of SLRs in a cohort of 200 patients. The clinical courses were characterized by a variety of symptoms, accompanied by cutaneous signs and extracutaneous manifestations such as bilateral, hilar lymphadenopathy. We identified a histologically granulomatous inflammation involving the skin, the lungs, and the lymph nodes. Two patients presented with cutaneous lesions only, and three patients had lung involvement only. Three patients achieved complete and partial response of the melanoma disease, and three patients had stable disease. Disease progression was documented in two patients. The reported immune-related adverse events were mild to severe and in most of the cases were continued without any treatment cessation. SLRs appear during treatment with both kinase and immune checkpoint inhibitors. Awareness of these can avoid misdiagnosis of disease progression and unnecessary treatment changes.
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16
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Habre M, Salloum A, Habre SB, Abi Chebl J, Dib R, Kourie HR. Skin adverse events in recently approved targeted therapies in solid malignancies. Future Oncol 2019; 15:331-343. [DOI: 10.2217/fon-2018-0402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Targeted anticancer therapies are an important weapon in the fight against cancer. Targeted therapies interfere with specific molecules necessary for tumor growth and cancer progression. They are divided mainly to either monoclonal antibodies or small molecules inhibitors. Their primary objective is to target directly and precisely the cancer cells leading to a minimal side-effects profile. The dermatologic adverse reactions of these targeted therapies is different from those seen with classical cytotoxic chemotherapy. Rashes, xerosis, hand-foot-skin reaction and mucositis are the most frequent side effects. In this paper, we aim to present a comprehensive review of the dermatologic side effects of targeted therapies including, specific side effects related to recently, approved targeted therapies.
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Affiliation(s)
- Maya Habre
- Department of Dermatology, Saint George Hospital, Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Antoine Salloum
- Department of Dermatology, Saint George Hospital, Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Samer Bassilios Habre
- Department of Plastic & Reconstructive Surgery, Saint George Hospital, Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Joanna Abi Chebl
- Saint George Hospital, Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Racha Dib
- Department of Internal Medicine, Centre Hospitalier Notre Dame de Secours, Faculty of Medicine, Université Saint Esprit Kaslik
| | - Hampig Raphael Kourie
- Unité de Génétique Médicale, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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17
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Chen L, Hsi AC, Kothari A, Dehner LP, Hayashi RJ, Coughlin CC. Granulomatous dermatitis secondary to vemurafenib in a child with Langerhans cell histiocytosis. Pediatr Dermatol 2018; 35:e402-e403. [PMID: 30216522 DOI: 10.1111/pde.13613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We present a 3-year-old boy with Langerhans cell histiocytosis who developed granulomatous dermatitis while taking vemurafenib. Vemurafenib currently has Food and Drug Administration approval for the treatment of BRAF V600E+ metastatic melanoma in adults, but recent discoveries of BRAF V600E in more than half of tested Langerhans cell histiocytosis lesions have prompted clinical trials of vemurafenib therapy for children with refractory, multisystem Langerhans cell histiocytosis. This report contributes to the knowledge of its potential side effects when used in children.
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Affiliation(s)
- Lily Chen
- School of Medicine, Washington University, St. Louis, Missouri
| | - Andy C Hsi
- Department of Pathology, California Skin Institute, San Jose, California.,Lauren V. Ackerman Laboratory of Surgical Pathology and Dermatopathology Center, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri
| | - Alok Kothari
- Division of Hematology/Oncology, Department of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri
| | - Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology and Dermatopathology Center, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri
| | - Robert J Hayashi
- Division of Hematology/Oncology, Department of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri
| | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, School of Medicine, Washington University, St. Louis, Missouri
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18
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Korman AM, Nisar MS, Somach SC. Subclinical granulomas in benign skin lesions heralding the onset of BRAF and MEK inhibitor-associated granulomatous dermatitis in a patient with metastatic melanoma. JAAD Case Rep 2018; 4:722-724. [PMID: 30167445 PMCID: PMC6113653 DOI: 10.1016/j.jdcr.2018.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Abraham M Korman
- Departments of Dermatology and Pathology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Mahrukh S Nisar
- Departments of Dermatology and Pathology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Stephen C Somach
- Departments of Dermatology and Pathology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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19
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Kubicki SL, Welborn ME, Garg N, Aung PP, Patel AB. Granulomatous dermatitis associated with ipilimumab therapy (ipilimumab associated granulomatous dermatitis). J Cutan Pathol 2018; 45:636-638. [PMID: 29704281 DOI: 10.1111/cup.13267] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/13/2018] [Accepted: 04/24/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Shelby L Kubicki
- Department of Dermatology, McGovern Medical School at UTHealth at Houston, Houston, Texas
| | - Macartney E Welborn
- Department of Dermatology, McGovern Medical School at UTHealth at Houston, Houston, Texas
| | - Naveen Garg
- Department of Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, Texas
| | - Phyu P Aung
- Department of Pathology, UT MD Anderson Cancer Center, Houston, Texas
| | - Anisha B Patel
- Department of Dermatology, McGovern Medical School at UTHealth at Houston, Houston, Texas.,Department of Dermatology, UT MD Anderson Cancer Center, Houston, Texas
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20
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Boada A, Carrera C, Segura S, Collgros H, Pasquali P, Bodet D, Puig S, Malvehy J. Cutaneous toxicities of new treatments for melanoma. Clin Transl Oncol 2018; 20:1373-1384. [PMID: 29799097 DOI: 10.1007/s12094-018-1891-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/09/2018] [Indexed: 12/13/2022]
Abstract
New drugs against advanced melanoma have emerged during last decade. Target therapy and immunotherapy have changed the management of patients with metastatic disease. Along with its generalized use, drug toxicities have appeared and the skin is the target organ of a significant part of them. This revision summarizes the most common side effects and consensus management to improve the compliance of therapies and patients' quality of life. Among the BRAF inhibitors, main cutaneous side effects are photosensitivity, plantar hyperkeratosis, and the appearance of verrucal keratosis or squamous cell carcinoma. Special attention must be paid to the development of new primary melanomas or changes on nevi during BRAF inhibitor therapy. The most common cutaneous side effects of immunotherapy are rash, pruritus, and vitiligo. It remains controversial the possible role of these toxicities as markers of response to therapy.
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Affiliation(s)
- A Boada
- Dermatology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Crta/Canyet s/n., Badalona, 08016, Barcelona, Spain.
| | - C Carrera
- Melanoma Unit, Dermatology Department, Hospital Clinic, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), CIBERER, Universitat de Barcelona, Barcelona, Spain
| | - S Segura
- Dermatology Department, Hospital del Mar, Parc de Salut Mar, Fundació Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - H Collgros
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sidney, Australia
| | - P Pasquali
- Dermatology Department, Pius Hospital Valls, Institut d'Investigació Sanitària Pere Virgili Valls, Tarragona, Spain
| | - D Bodet
- Dermatology Department, Hospital Universitari Vall d'Hebron, VHIR, Barcelona, Spain
| | - S Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), CIBERER, Universitat de Barcelona, Barcelona, Spain
| | - J Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clinic, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), CIBERER, Universitat de Barcelona, Barcelona, Spain
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21
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Chopra A, Nautiyal A, Kalkanis A, Judson MA. Drug-Induced Sarcoidosis-Like Reactions. Chest 2018; 154:664-677. [PMID: 29698718 DOI: 10.1016/j.chest.2018.03.056] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 01/02/2023] Open
Abstract
A drug-induced sarcoidosis-like reaction (DISR) is a systemic granulomatous reaction that is indistinguishable from sarcoidosis and occurs in a temporal relationship with initiation of an offending drug. DISRs typically improve or resolve after withdrawal of the offending drug. Four common categories of drugs that have been associated with the development of a DISR are immune checkpoint inhibitors, highly active antiretroviral therapy, interferons, and tumor necrosis factor-α antagonists. Similar to sarcoidosis, DISRs do not necessarily require treatment because they may cause no significant symptoms, quality of life impairment, or organ dysfunction. When treatment of a DISR is required, standard antisarcoidosis regimens seem to be effective. Because a DISR tends to improve or resolve when the offending drug is discontinued, this is another effective treatment for a DISR. However, the offending drug need not be discontinued if it is useful, and antigranulomatous therapy can be added. In some situations, the development of a DISR may suggest a beneficial effect of the inducing drug. Understanding the mechanisms leading to DISRs may yield important insights into the immunopathogenesis of sarcoidosis.
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Affiliation(s)
- Amit Chopra
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY.
| | - Amit Nautiyal
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
| | - Alexander Kalkanis
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, 401 Military and VA Hospital, Athens, Greece
| | - Marc A Judson
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
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22
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Reinhard R, Gebhardt C, Schmieder A, Umansky V, Utikal J. Recurrent tattoo reactions in a patient treated with BRAF and MEK inhibitors. J Eur Acad Dermatol Venereol 2017; 31:e375-e377. [DOI: 10.1111/jdv.14181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- R. Reinhard
- Department of Dermatology, Venereology and Allergology; University Medical Center Mannheim; Ruprecht-Karl University of Heidelberg; Mannheim Germany
- Skin Cancer Unit; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - C. Gebhardt
- Department of Dermatology, Venereology and Allergology; University Medical Center Mannheim; Ruprecht-Karl University of Heidelberg; Mannheim Germany
- Skin Cancer Unit; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - A. Schmieder
- Department of Dermatology, Venereology and Allergology; University Medical Center Mannheim; Ruprecht-Karl University of Heidelberg; Mannheim Germany
| | - V. Umansky
- Department of Dermatology, Venereology and Allergology; University Medical Center Mannheim; Ruprecht-Karl University of Heidelberg; Mannheim Germany
- Skin Cancer Unit; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - J. Utikal
- Department of Dermatology, Venereology and Allergology; University Medical Center Mannheim; Ruprecht-Karl University of Heidelberg; Mannheim Germany
- Skin Cancer Unit; German Cancer Research Center (DKFZ); Heidelberg Germany
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23
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Abstract
Adverse drug reactions (ADRs) are a common cause of dermatologic consultation, involving 2 to 3 per 100 medical inpatients in the United States. Female patients are 1.3 to 1.5 times more likely to develop ADRs, except in children less than 3 years of age, among whom boys are more often affected. Certain drugs are more frequent causes, including aminopenicillins, trimethoprim-sulfamethoxazole, and nonsteroidal antiinflammatory drugs. Chemotherapeutic agents commonly cause adverse reactions to the skin and nails, with certain agents causing particular patterns of reactions. ADRs can involve any area of the skin; the appendages, including hair and nails; as well as mucosa.
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24
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BRAF Inhibitor-Induced Antitumoral Granulomatous Dermatitis Eruption in Advanced Melanoma. Am J Dermatopathol 2016; 37:795-8. [PMID: 26381028 DOI: 10.1097/dad.0000000000000281] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Recent advances in targeting BRAF mutations, which occur in roughly 50% of the melanomas, have improved response rates and overall survival in patients with advanced disease. With the increasingly extensive use of the drug, new, nonpreventable, cutaneous and noncutaneous toxicities keep arising as infrequent adverse effects. We report a 55-year-old man with a history of metastatic melanoma treated with the dabrafenib who presented, 10 months after the initiation of the treatment, with erythematous, slightly squamous, round plaques on his upper trunk and on his left upper arm. Two skin biopsies from the lesions revealed a granulomatous dermatitis in the superficial reticular dermis. One of them showed admixed abundant melanophages from tumoral melanosis. No melanoma cells were seen in any of the specimens. No interruption of the treatment was necessary. Our observation indicates that such a response may represent a positive immune activation triggered by BRAF inhibitors. The erythematous rash was initially concerning for progression of metastatic disease, which suggests that a close monitoring of the patients with advanced melanomas treated with vemurafenib is advisable to prevent unnecessary discontinuation of the therapy.
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25
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Abstract
Granuloma formation is usually regarded as a means of defending the host from persistent irritants of either exogenous or endogenous origin. Noninfectious granulomatous disorders of the skin encompass a challenging group of diseases owing to their clinical and histologic overlap. Drug reactions characterized by a granulomatous reaction pattern are rare, and defined by a predominance of histiocytes in the inflammatory infiltrate. This review summarizes current knowledge on the various types of granulomatous drug eruptions, focusing on the 4 major types: interstitial granulomatous drug reaction, drug-induced accelerated rheumatoid nodulosis, drug-induced granuloma annulare, and drug-induced sarcoidosis.
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Affiliation(s)
- Roni P Dodiuk-Gad
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room M1-737, Toronto, ON M4N 3M5, Canada; Department of Dermatology, Ha'emek Medical Center, Afula 18101, Israel
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room M1-737, Toronto, ON M4N 3M5, Canada; Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room M1-737, Toronto, Ontario M4N 3M5, Canada.
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26
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Cutaneous Side Effects of BRAF Inhibitors in Advanced Melanoma: Review of the Literature. Dermatol Res Pract 2016; 2016:5361569. [PMID: 27042173 PMCID: PMC4794559 DOI: 10.1155/2016/5361569] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/07/2016] [Accepted: 02/15/2016] [Indexed: 01/08/2023] Open
Abstract
The incidence of melanoma has recently been increasing. BRAF mutations have been found in 40–60% of melanomas. The increased activity of BRAF V600E leads to the activation of downstream signaling through the mitogen-activated protein kinase (MAPK) pathway, which plays a key role as a regulator of cell growth, differentiation, and survival. The use of BRAF inhibitors in metastatic melanoma with BRAF mutation ensures clinical improvement of the disease. Vemurafenib and dabrafenib are two selective BRAF inhibitors approved by the Food and Drug Administration (FDA). Both drugs are well tolerated and successfully used in clinical practice. However, some adverse reactions have been reported in patients in the course of treatment. Cutaneous side effects are the most common adverse events among them with a broad spectrum. Both the case reports and several original clinical trials reported cutaneous reactions during the treatment with BRAF inhibitors. In this review, the common cutaneous side effects of BRAF inhibitors in the treatment of metastatic melanoma with BRAF V600E mutation were reviewed.
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27
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Leal L, Agut-Busquet E, Romani J, Sabat M, Yebenes M, Saez A, Luelmo J. Cutaneous granulomatous panniculitis and sarcoidal granulomatous papular eruption in a patient with metastatic melanoma treated with a BRAF inhibitor. J Dermatol 2016; 43:715-6. [PMID: 26777901 DOI: 10.1111/1346-8138.13255] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Lorena Leal
- Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Eugenia Agut-Busquet
- Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Jorge Romani
- Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Mireia Sabat
- Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Mireia Yebenes
- Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Amparo Saez
- Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Jesus Luelmo
- Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
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28
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Granulomatous nephritis and dermatitis in a patient with BRAF V600E mutant metastatic melanoma treated with dabrafenib and trametinib. Melanoma Res 2015; 25:550-4. [DOI: 10.1097/cmr.0000000000000186] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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29
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Sinha R, Larkin J, Gore M, Fearfield L. Cutaneous toxicities associated with vemurafenib therapy in 107 patients with BRAF V600E mutation-positive metastatic melanoma, including recognition and management of rare presentations. Br J Dermatol 2015; 173:1024-31. [PMID: 26109403 DOI: 10.1111/bjd.13958] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Vemurafenib significantly improved overall survival compared with dacarbazine in patients with metastatic or unresectable BRAF V600E-positive melanoma in the BRIM-3 trial. However, vemurafenib was associated with a number of skin-related adverse events (AEs). OBJECTIVES To investigate the incidence and management of vemurafenib-associated skin AEs. METHODS This retrospective, observational study included adult patients with stage IIIC or IV melanoma who received vemurafenib between March 2010 and August 2013. Patients received oral vemurafenib 960 mg twice daily, with dose interruptions and reductions allowed for AE management. RESULTS In total 107 patients were treated with vemurafenib during the study period. The most frequent clinically important skin-related AEs were rash (64%), squamoproliferative growths (41%), photosensitivity (40%) and squamous cell carcinoma (SCC) or keratoacanthoma (KA; 20%). Rare cases of granulomatous dermatitis and cutaneous T-cell lymphoma were also found. Rash was manageable with corticosteroids and dose modifications; squamoproliferative growths and SCCs/KAs were treated with cryotherapy and surgical excision, respectively. Patients were counselled regarding phototoxicity. The uncontrolled nature and retrospective design of the study, and the small patient numbers are limitations. CONCLUSIONS Vemurafenib appears to have a predictable and manageable AE profile. Proactive management can limit the impact of AEs on patients, allowing treatment to continue despite toxicities.
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Affiliation(s)
- R Sinha
- Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, U.K.,Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, U.K
| | - J Larkin
- Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, U.K
| | - M Gore
- Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, U.K
| | - L Fearfield
- Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, U.K.,Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, U.K
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30
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Lheure C, Kramkimel N, Franck N, Laurent-Roussel S, Carlotti A, Queant A, Goldwasser F, Avril MF, Dupin N. Sarcoidosis in Patients Treated with Vemurafenib for Metastatic Melanoma: A Paradoxical Autoimmune Activation. Dermatology 2015; 231:378-84. [PMID: 26452227 DOI: 10.1159/000439400] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vemurafenib, a BRAF inhibitor, is a first-line treatment for inoperable melanoma. Sarcoidosis has never been reported in patients on vemurafenib. OBJECTIVES We describe 5 cases of sarcoidosis in patients treated with vemurafenib. METHODS Seventy patients receiving vemurafenib for a BRAF-mutated inoperable stage III or IV melanoma were treated in our centre. RESULTS Five patients (7.1%) developed sarcoidosis or a sarcoid-like reaction on vemurafenib; 4 patients had cutaneous signs and 3 had extracutaneous disorders (bilateral hilar lymph nodes, uveitis). Histological analysis of skin lesions revealed epithelioid granulomas without necrosis, consistent with sarcoidosis. Angiotensin-converting enzyme levels were high in 2 patients. Cutaneous and ophthalmological lesions rapidly disappeared on topical corticosteroid treatment without the cessation of vemurafenib treatment. Complete remission of melanoma was observed in 3 patients and partial remission was observed in another. CONCLUSION BRAF inhibitors probably have immune system-enhancing effects and should therefore be recognized as potential inducers of sarcoidosis.
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Affiliation(s)
- Coralie Lheure
- Service de Dermatologie, Hx00F4;pital Cochin, Assistance Publique - Hx00F4;pitaux de Paris (APHP), Paris, France
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31
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Bar-Sela G, Abu-Amna M, Hadad S, Haim N, Shahar E. Successful desensitization protocol for hypersensitivity reaction probably caused by dabrafenib in a patient with metastatic melanoma. Jpn J Clin Oncol 2015; 45:881-3. [PMID: 26056325 DOI: 10.1093/jjco/hyv086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/10/2015] [Indexed: 11/13/2022] Open
Abstract
Vemurafenib and dabrafenib are both orally bioavailable small molecule agents that block mitogen activated protein kinase signalling in patients with melanoma and BRAF(V600E) mutation. Generalized hypersensitivity reactions to vemurafenib or dabrafenib have not been described. Continuing vemurafenib or dabrafenib therapy despite hypersensitivity reaction is especially important in patients with melanoma and BRAF(V600E) mutation, in whom this mutation plays a critical role in tumour growth. Desensitization protocols to overcome hypersensitivity reactions by gradual reintroduction of small amounts of the offending drug up to full therapeutic doses are available for many anti-cancer agents, including vemurafenib but, to the best of our knowledge, have not been reported for dabrafenib. We describe a patient with metastatic melanoma who developed Type I hypersensitivity reaction to vemurafenib and to subsequent treatment with dabrafenib, and who was successfully treated by drug desensitization which allowed safe prolonged continuation of dabrafenib. The development of hypersensitivity reactions for both dabrafenib and vemurafinib in the current case could be because these drugs have a similar chemical structure and cause a cross-reactivity. However, hypersensitivity reaction to a non-medicinal ingredient shared by the two drugs is also possible. Oral desensitization appears to be an option for patients with hypersensitivity Type I to dabrafenib. This approach may permit clinicians to safely administer dabrafenib to patients who experience hypersensitivity reactions to this life-prolonging medication.
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Affiliation(s)
- Gil Bar-Sela
- Division of Oncology, Technion-Israel Institute of Technology, Haifa
| | - Mahmoud Abu-Amna
- Division of Oncology, Technion-Israel Institute of Technology, Haifa
| | - Salim Hadad
- Pharmacy Department, Technion-Israel Institute of Technology, Haifa
| | - Nissim Haim
- Division of Oncology, Technion-Israel Institute of Technology, Haifa
| | - Eduardo Shahar
- Department of Immunology, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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32
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Rosenbach M, English JC. Reactive Granulomatous Dermatitis: A Review of Palisaded Neutrophilic and Granulomatous Dermatitis, Interstitial Granulomatous Dermatitis, Interstitial Granulomatous Drug Reaction, and a Proposed Reclassification. Dermatol Clin 2015; 33:373-87. [PMID: 26143420 DOI: 10.1016/j.det.2015.03.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The terms "palisaded neutrophilic and granulomatous dermatitis," "interstitial granulomatous dermatitis," and the subset "interstitial granulomatous drug reaction" are a source of confusion. There exists substantial overlap among the entities with few strict distinguishing features. We review the literature and highlight areas of distinction and overlap, and propose a streamlined diagnostic workup for patients presenting with this cutaneous reaction pattern. Because the systemic disease associations and requisite workup are similar, and the etiopathogenesis is poorly understood but likely similar among these entities, we propose the simplified unifying term "reactive granulomatous dermatitis" to encompass these entities.
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Affiliation(s)
- Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Joseph C English
- University of Pittsburgh, Department of Dermatology, UPMC North Hills Dermatology, Wexford, PA, USA
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33
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Gutzmer R, Hassel JC, Kähler KC, Loquai C, Mössner R, Ugurel S, Zimmer L, der das Ado FKKNA. [Cutaneous side effects of anti-tumor therapy with BRAF and MEK inhibitors]. Hautarzt 2015; 65:582-9. [PMID: 24903029 DOI: 10.1007/s00105-013-2733-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND BRAF and MEK inhibitors are new targeted therapies which are used in the treatment of malignancies, in particular of malignant melanoma. SIDE EFFECTS Cutaneous side effects are common during the treatment with both types of inhibitors. These side effects include inflammatory reactions such as maculopapular and papulopustular exanthema, hand-foot syndrome, panniculitis, paronychia, photo- and radio-sensitization. As a class effect, BRAF-inhibitors induce proliferative disorders of keratinocytes and melanocytes, such as palmoplantar hyperkeratosis (as part of the hand-foot syndrome), verruciform and acanthoma-like lesions, follicular and Grover disease-like hyperkeratoses, keratoacanthomas, squamous cell carcinomas and atypical melanocytic nevi with transition to secondary melanomas. Furthermore, hair alterations and xerosis are possible. CONCLUSIONS Treatment with BRAF and MEK inhibitors requires close dermatologic monitoring of the patient. This manuscript summarizes the most frequent cutaneous side effects and their management.
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Affiliation(s)
- R Gutzmer
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover (HTZH), Medizinische Hochschule Hannover, Ricklinger Str. 5, 30449, Hannover, Deutschland,
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34
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BRAF inhibitors: experience in thyroid cancer and general review of toxicity. Discov Oncol 2014; 6:21-36. [PMID: 25467940 DOI: 10.1007/s12672-014-0207-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/11/2014] [Indexed: 12/20/2022] Open
Abstract
The US Food and Drug Administration-approved BRAF inhibitors, vemurafenib and dabrafenib, have demonstrated superior efficacy in patients with BRAF-mutant melanomas but have limited efficacy in BRAF-mutant colorectal cancer. Little is known at this time regarding BRAF inhibitors in thyroid cancer. Initial reports in patients with progressive, radioactive iodine-refractory BRAF-mutant papillary thyroid cancer suggest response rates of approximately 30-40%. In this review, we discuss BRAF inhibitors in the context of thyroid cancer, the toxicities associated with BRAF inhibitors, and the suggested management of those toxicities. The management of vemurafenib and dabrafenib toxicities is applicable across all tumor types and may serve as a practical guide to their use.
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35
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Abstract
Patients treated with ipilimumab or targeted inhibitors of the RAF-MEK-ERK pathway (vemurafenib, dabrafenib, and trametinib) for advanced cutaneous melanoma often experience drug-related skin toxicities denoted as dermatologic adverse events (DAEs). Although rarely life-threatening, DAEs may emerge dramatically and potentially compromise oncologic therapy if not managed in a timely and effective manner. Early recognition of DAEs is critical to providing optimal skin care and prompt consultation with a dermatologist should be obtained when a diagnosis is unclear. The expanding utilization of new melanoma drugs compels physicians to maintain a watchful eye for both known and novel DAEs and to adopt a low threshold to biopsy worrisome skin findings. Numerous therapeutic options are available to manage DAEs including topical and systemic agents as well as surgical and destructive modalities. Applying such methods improves overall patient care and optimizes the effectiveness of new therapies for advanced cutaneous melanoma.
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Affiliation(s)
- John C Mavropoulos
- Department of Dermatology, Johns Hopkins Outpatient Center, Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA,
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