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Peacock BC, Tripathy S, Hanania HL, Wang HY, Sadighi Z, Patel AB. Cutaneous toxicities of mitogen-activated protein kinase inhibitors in children and young adults with neurofibromatosis-1. J Neurooncol 2024; 167:515-522. [PMID: 38443692 DOI: 10.1007/s11060-024-04617-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder which commonly causes neoplasms leading to disfigurement or dysfunction. Mitogen-activated protein kinase inhibitors (MEKi) are generally well-tolerated treatments which target neural tumor progression in patients with NF1. However, cutaneous adverse events (CAEs) are common and may hinder patients' abilities to remain on treatment, particularly in children. We aim to characterize CAEs secondary to MEKi treatment in pediatric and young adult patients with NF1. METHODS We reviewed institutional medical records of patients under 30 years with a diagnosis of "NF1," "NF2," or "other neurofibromatoses" on MEKi therapy between January 1, 2019 and June 1, 2022. We recorded the time-to-onset, type, and distribution of CAEs, non-cutaneous adverse events (AEs), AE management, and tumor response. RESULTS Our cohort consisted of 40 patients with NF1 (median age, 14 years). Tumor types included low-grade gliomas (51%) and plexiform neurofibromas (38%). MEKi used included selumetinib (69%), trametinib (25%), and mirdametinib (6%). A total of 74 CAEs occurred, with 28 cases of acneiform rash (38%). Other common CAEs were paronychia, seborrheic dermatitis, eczema, xerosis, and oral mucositis. The most common treatments included oral antibiotics and topical corticosteroids. Most patients had clinical (stable or improved) tumor response (71%) while 29% had tumor progression while on a MEKi. There was no significant association between CAE presence and tumor response (p = 0.39). CONCLUSIONS Improvement in characterization of MEKi toxicities and their management is important to develop treatment guidelines for pediatric and young adult patients with NF1 on MEKi therapy.
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Affiliation(s)
- Brianna C Peacock
- Texas A&M University School of Engineering Medicine, Houston, TX, USA
| | - Sanjna Tripathy
- McGovern Medical School, The University of Texas Health Sciences Center, Houston, TX, USA
| | | | | | - Zsila Sadighi
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anisha B Patel
- Department of Dermatology, Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Box 1452, Houston, TX, 77030, USA.
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Haynes D, Morgan EE, Chu EY. Cutaneous adverse reactions resulting from targeted cancer therapies: histopathologic and clinical findings. Hum Pathol 2023; 140:129-143. [PMID: 37146945 DOI: 10.1016/j.humpath.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
Targeted cancer treatments-designed to interfere with specific molecular signals responsible for tumor survival and progression-have shown benefit over conventional chemotherapies but may lead to diverse cutaneous adverse effects. This review highlights clinically significant dermatologic toxicities and their associated histopathologic findings, resulting from various targeted cancer drugs. Case reports and series, clinical trials, reviews, and meta-analyses are included for analysis and summarized herein. Cutaneous side effects resulting from targeted cancer therapies were reported with incidences as high as 90% for certain medications, and reactions are often predictable based on mechanism(s) of action of a given drug. Common and important reaction patterns included: acneiform eruptions, neutrophilic dermatoses, hand-foot skin reaction, secondary cutaneous malignancies, and alopecia. Clinical and histopathologic recognition of these toxicities remains impactful for patient care.
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Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Eric E Morgan
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104 USA
| | - Emily Y Chu
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Kozubek P, Wołoszczak J, Gomułka K. Immune Reactions in Major Types of Oncological Treatment. Int J Mol Sci 2023; 24:11257. [PMID: 37511017 PMCID: PMC10378943 DOI: 10.3390/ijms241411257] [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: 05/30/2023] [Revised: 06/24/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
In recent years, there has been a noticeable development in oncological treatment, including chemotherapy and biological treatment. Despite their significant effectiveness, they are not free from side effects, such as allergic and dermatological reactions. These reactions can vary in severity and outcome, including potential death. Examples, among others, are type I-IV hypersensitivity reactions of various origins and skin reactions including rashes, itching and redness, but also severe cutaneous syndromes. Due to the therapy used, these may include Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms, drug-induced hypersensitivity syndrome and acute generalized exanthematous pustulosis. In some cases, it is necessary to interrupt therapy, which may result in a poorer outcome and shorten the patient's survival. This paper reviews various types of research documents published since 2016. It aims to systematize the latest knowledge and highlight the need for further research into ways to avoid adverse reactions.
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Affiliation(s)
- Patrycja Kozubek
- Student Scientific Group of Adult Allergology, 50-369 Wrocław, Poland
| | - Julia Wołoszczak
- Student Scientific Group of Adult Allergology, 50-369 Wrocław, Poland
| | - Krzysztof Gomułka
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, 50-369 Wrocław, Poland
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Ambur A, Clark A, Nathoo R. An Updated Review of the Therapeutic Management of Keratoacanthomas. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:S16-S22. [PMID: 36588786 PMCID: PMC9769584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective Keratoacanthomas are fast-growing cutaneous neoplasms that can be difficult to distinguish from squamous cell carcinoma, both clinically and histologically. The uncertain behavior of these neoplasms creates a challenge in management, and treatment choice often varies significantly between cases. The objective of this review is to discuss the most common and up-to-date treatment modalities used in the management of keratoacanthomas. Methods A literature search was performed using PubMed to access and review relevant keratoacanthoma treatment modalities published within the last 40 years. Keywords searched included "keratoacanthoma," "Grzybowski syndrome," "Ferguson-Smith syndrome," "Witten-Zac syndrome," and "Muir-Torre" syndrome. Results Our search resulted in 3,408 articles, of which 67 articles were ultimately included in this review. Conclusion Although surgical removal with excision or Mohs micrographic surgery remains the standard of therapy, there are many alternative therapeutic modalities that can be utilized.
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Ambur A, Clark A, Nathoo R. An Updated Review of the Therapeutic Management of Keratoacanthomas. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:30-36. [PMID: 36381181 PMCID: PMC9651152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Keratoacanthomas are fast-growing cutaneous neoplasms that can be difficult to distinguish from squamous cell carcinoma, both clinically and histologically. The uncertain behavior of these neoplasms creates a challenge in management, and treatment choice often varies significantly between cases. The objective of this review is to discuss the most common and up-to-date treatment modalities used in the management of keratoacanthomas. METHODS A literature search was performed using PubMed to access and review relevant keratoacanthoma treatment modalities published within the last 40 years. Keywords searched included "keratoacanthoma," "Grzybowski syndrome," "Ferguson-Smith syndrome," "Witten-Zac syndrome," and "Muir-Torre" syndrome. RESULTS Our search resulted in 3,408 articles, of which 67 articles were ultimately included in this review. CONCLUSION Although surgical removal with excision or Mohs micrographic surgery remains the standard of therapy, there are many alternative therapeutic modalities that can be utilized.
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Affiliation(s)
- Austin Ambur
- All authors are with the Department of Dermatology at KCU-GME Advanced Dermatology and Cosmetic Surgery in Oviedo, Florida
| | - Abigale Clark
- All authors are with the Department of Dermatology at KCU-GME Advanced Dermatology and Cosmetic Surgery in Oviedo, Florida
| | - Rajiv Nathoo
- All authors are with the Department of Dermatology at KCU-GME Advanced Dermatology and Cosmetic Surgery in Oviedo, Florida
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Mihai MM, Ion A, Giurcăneanu C, Nițipir C, Popa AM, Chifiriuc MC, Popa MI, Říčař J, Popa LG, Sârbu I, Lazăr V. The Impact of Long-Term Antibiotic Therapy of Cutaneous Adverse Reactions to EGFR Inhibitors in Colorectal Cancer Patients. J Clin Med 2021; 10:jcm10153219. [PMID: 34362003 PMCID: PMC8347035 DOI: 10.3390/jcm10153219] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC) is an important public health issue, in terms of incidence and mortality, with approximately 1.8 million new cases reported worldwide in 2018. Advancements in understanding pathophysiological key steps in CRC tumorigenesis have led to the development of new targeted therapies such as those based on epidermal growth factor receptor inhibitors (EGFR inhibitors). The cutaneous adverse reactions induced by EGFR inhibitors, particularly papulopustular rash, often require long-term antibiotic treatment with tetracycline agents (mostly minocycline and doxycycline). However, this raises several issues of concern: possible occurrence of gut dysbiosis in already vulnerable CRC patients, selection of highly antibiotic resistant and/or virulent clones, development of adverse reactions related to tetracyclines, interference of antibiotics with the response to oncologic therapy, with a negative impact on disease prognosis etc. In the context of scarce information regarding these issues and controversial opinions regarding the role of tetracyclines in patients under EGFR inhibitors, our aim was to perform a thorough literature review and discuss the main challenges raised by long-term use of tetracyclines in advanced CRC patients receiving this targeted therapy.
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Affiliation(s)
- Mara Mădălina Mihai
- Department of Oncologic Dermatology, ‘Elias’ Emergency University Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.G.); (L.G.P.)
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania
- Department of Microbiology, Faculty of Biology, ICUB—Research Institute of the University of Bucharest, 050657 Bucharest, Romania; (M.-C.C.); (V.L.)
- Correspondence: (M.M.M.); (A.I.); Tel.: +40-74-336-4164 (M.M.M.)
| | - Ana Ion
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania
- Correspondence: (M.M.M.); (A.I.); Tel.: +40-74-336-4164 (M.M.M.)
| | - Călin Giurcăneanu
- Department of Oncologic Dermatology, ‘Elias’ Emergency University Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.G.); (L.G.P.)
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania
| | - Cornelia Nițipir
- Department of Oncology, ‘Elias’ Emergency University Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.N.); (A.-M.P.)
| | - Ana-Maria Popa
- Department of Oncology, ‘Elias’ Emergency University Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.N.); (A.-M.P.)
| | - Mariana-Carmen Chifiriuc
- Department of Microbiology, Faculty of Biology, ICUB—Research Institute of the University of Bucharest, 050657 Bucharest, Romania; (M.-C.C.); (V.L.)
| | - Mircea Ioan Popa
- Department of Microbiology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Jan Říčař
- Department of Dermatology and Venereology, Charles University, Medical School and Teaching Hospital Pilsen, 30599 Pilsen, Czech Republic;
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology, ‘Elias’ Emergency University Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.G.); (L.G.P.)
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania
| | - Ionela Sârbu
- Department of Genetics, Faculty of Biology, ICUB—Research Institute of the University of Bucharest, 050657 Bucharest, Romania;
| | - Veronica Lazăr
- Department of Microbiology, Faculty of Biology, ICUB—Research Institute of the University of Bucharest, 050657 Bucharest, Romania; (M.-C.C.); (V.L.)
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