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Ziemer M, Livingstone E. [Drug-related exanthema under immunotherapy and targeted oncological therapy]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:440-450. [PMID: 38772932 DOI: 10.1007/s00105-024-05350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Oncological therapies can cause a variety of mucocutaneous adverse events. Exanthematous adverse events can be challenging in the context of the urgent need for cancer treatment due to their spread, sometimes rapid progression, and mucous membrane or organ involvement. MATERIALS AND METHODS This article provides an overview of the most important exanthematic dermatoses as side effects of modern drug-based tumor therapies with diagnostic and therapeutic information for clinicians, taking into account the current literature and guidelines. RESULTS Exanthematous adverse events of immune checkpoint inhibitors, EGFR antagonists, kinase inhibitors, bispecific T‑cell engagers, and the CCR4 inhibitor mogamulizumab are reviewed in detail. CONCLUSIONS Cutaneous side effects are common across all drug classes and cover a broad spectrum. While some adverse events are specific to one drug class, many exanthemas can occur with both oncological immunotherapies and various targeted therapies. A reliable diagnosis, dose adjustment or discontinuation of the offending agent in consultation with the treating oncologists and appropriate symptomatic therapy are important for correct management. In the case of severe, life-threatening drug reactions, however, permanent discontinuation of the drug is essential.
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Affiliation(s)
- Mirjana Ziemer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Leipzig, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland.
| | - Elisabeth Livingstone
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsmedizin Essen, Hufelandstr. 55, 45122, Essen, Deutschland
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2
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Tolerability of BRAF and MEK Inhibitors for Metastasized Melanoma after Intra-Class Switch: A Multicenter, Retrospective Study. Cancers (Basel) 2023; 15:cancers15051426. [PMID: 36900217 PMCID: PMC10001327 DOI: 10.3390/cancers15051426] [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: 01/13/2023] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023] Open
Abstract
Targeted therapy with BRAF and MEK inhibitors (BRAFi, MEKi) is one of the mainstays of melanoma treatment. When dose-limiting toxicity (DLT) is observed, an option represents the intra-class switch to a different BRAFi+MEKi combination. Currently, there is scarce evidence for this procedure. This is a multicenter, retrospective analysis from six German skin cancer centers of patients who received two different combinations of BRAFi and MEKi. In total, 94 patients were included: 38 patients (40%) were re-exposed with a different combination because of previous unacceptable toxicity, 51 (54%) were re-exposed after progression, and 5 (5%) were included for other reasons. Of the 44 patients with a DLT during their first BRAFi+MEKi combination, only five (11%) experienced the same DLT during their second combination. A new DLT was experienced by 13 patients (30%). Six patients (14%) had to discontinue the second BRAFi treatment due to its toxicity. Compound-specific adverse events were avoided in the majority of patients by switching to a different combination. Efficacy data were similar to historical cohorts of BRAFi+MEKi rechallenge, with an overall response rate of 31% for patients who had previously progressed to treatment. We conclude that switching to a different BRAFi+MEKi combination if dose-limiting toxicity occurs is a feasible and rational approach in patients with metastatic melanoma.
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Bumbacea RS, Ali S, Corcea SL, Jinga DC, Spiru L. Successful Dabrafenib Desensitization Protocols in a Patient with Metastatic Melanoma. Medicina (B Aires) 2022; 58:medicina58040511. [PMID: 35454350 PMCID: PMC9029543 DOI: 10.3390/medicina58040511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 12/02/2022] Open
Abstract
Dabrafenib and trametinib are two available molecules that have been approved for the treatment of metastatic melanoma with BRAF-V600E or V600K mutations. Their combined therapy has led to long-lasting survival benefits and substantially improved outcomes. Until now, only a few cases of severe hypersensitivity reactions to dabrafenib and vemurafenib have been reported, and even fewer desensitization protocols to these molecules have been documented. We report the case of a 71-year-old female patient with metastatic melanoma harboring a BRAF-V600E mutation undergoing targeted therapy with dabrafenib and trametinib. Two weeks after the initiation of the combined treatment, she developed a hypersensitivity reaction. The cause–effect relationship between dabrafenib and the hypersensitivity reaction was demonstrated twice, when symptoms recurred upon dabrafenib reintroduction. We started a rapid 3-day dabrafenib desensitization protocol, which was well tolerated. When the patient discontinued the drug administration, we decided on a longer protocol that included more steps and more days in order to prevent the occurrence of other hypersensitivity reactions. Our patient tolerated both rapid and slow-going schedules, the first one reaching the final dose within 3 days and the second one reaching the total daily dose within 14 days. Depending on the patient’s needs, the severity of the hypersensitivity reaction and the hospital’s availability, the doctor may choose either the rapid or slow-going desensitization protocol.
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Affiliation(s)
- Roxana Silvia Bumbacea
- Department of Allergology “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Allergy and Clinical Immunology, “Dr. Carol Davila” Nephrology Clinical Hospital, 010731 Bucharest, Romania
| | - Selda Ali
- Department of Allergology “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Allergy and Clinical Immunology, “Dr. Carol Davila” Nephrology Clinical Hospital, 010731 Bucharest, Romania
- Correspondence: ; Tel.: +40-723-668423
| | - Sabina Loredana Corcea
- Department of Pharmacology “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Novomedica Center of Excellence, 030167 Bucharest, Romania
| | - Dan Corneliu Jinga
- Department of Medical Oncology, Neolife Medical Center, 013812 Bucharest, Romania;
| | - Luiza Spiru
- Department of Geriatrics and Gerontology “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “Ana Aslan” International Foundation, 020771 Bucharest, Romania
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Batinac T, Hlača N, Simetić L, Valković F, Peternel S, Prpić-Massari L. Stevens-Johnson Syndrome and Severe Anaemia: A Case of Toxicity Induced by Vemurafenib plus Cobimetinib following Pembrolizumab for Metastatic Melanoma. Acta Derm Venereol 2022; 102:adv00650. [PMID: 35146529 PMCID: PMC9558335 DOI: 10.2340/actadv.v102.1433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | | | | | - Sandra Peternel
- Department of Dermatovenereology, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, HR-51000, Rijeka, Croatia.
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5
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Kohlmann J, Reschke R, Mockenhaupt M, Ziemer M. Severe skin eruption with features of drug reaction with eosinophilia and systemic symptoms (DRESS) during vemurafenib treatment of melanoma. J Eur Acad Dermatol Venereol 2021; 36:e242-e244. [PMID: 34704628 DOI: 10.1111/jdv.17775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- J Kohlmann
- Department of Dermatology, University of Leipzig Medical Center, Leipzig, Germany
| | - R Reschke
- Department of Dermatology, University of Leipzig Medical Center, Leipzig, Germany
| | - M Mockenhaupt
- Dokumentationszentrum schwerer Hautreaktionen' (dZh) Department of Dermatology, Medical Center and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - M Ziemer
- Department of Dermatology, University of Leipzig Medical Center, Leipzig, Germany
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Bourque MS, Salek M, Sabin ND, Canale M, Upadhyaya SA. Comment on: Response to the BRAF/MEK inhibitors dabrafenib/trametinib in an adolescent with a BRAF V600E mutated anaplastic ganglioglioma intolerant to vemurafenib. Pediatr Blood Cancer 2021; 68:e28814. [PMID: 33211390 DOI: 10.1002/pbc.28814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Melissa S Bourque
- Department of Pharmaceutical Services, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Marta Salek
- Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Noah D Sabin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Meredith Canale
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Santhosh A Upadhyaya
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Successful transition to encorafenib following vemurafenib-induced drug rash with eosinophilia and systemic symptoms syndrome. JAAD Case Rep 2021; 9:42-44. [PMID: 33644278 PMCID: PMC7895670 DOI: 10.1016/j.jdcr.2020.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Torres‐Navarro I, de Unamuno‐Bustos B, Botella‐Estrada R. Systematic review of BRAF/MEK inhibitors‐induced Severe Cutaneous Adverse Reactions (SCARs). J Eur Acad Dermatol Venereol 2020; 35:607-614. [DOI: 10.1111/jdv.16894] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022]
Affiliation(s)
- I. Torres‐Navarro
- Dermatology Department Hospital Universitario y Politécnico la Fe València Spain
| | - B. de Unamuno‐Bustos
- Dermatology Department Hospital Universitario y Politécnico la Fe València Spain
| | - R. Botella‐Estrada
- Dermatology Department Hospital Universitario y Politécnico la Fe València Spain
- Department of Medicine Universitat de València València Spain
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9
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Hartman ML. Non-Apoptotic Cell Death Signaling Pathways in Melanoma. Int J Mol Sci 2020; 21:E2980. [PMID: 32340261 PMCID: PMC7215321 DOI: 10.3390/ijms21082980] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022] Open
Abstract
Resisting cell death is a hallmark of cancer. Disturbances in the execution of cell death programs promote carcinogenesis and survival of cancer cells under unfavorable conditions, including exposition to anti-cancer therapies. Specific modalities of regulated cell death (RCD) have been classified based on different criteria, including morphological features, biochemical alterations and immunological consequences. Although melanoma cells are broadly equipped with the anti-apoptotic machinery and recurrent genetic alterations in the components of the RAS/RAF/MEK/ERK signaling markedly contribute to the pro-survival phenotype of melanoma, the roles of autophagy-dependent cell death, necroptosis, ferroptosis, pyroptosis, and parthanatos have recently gained great interest. These signaling cascades are involved in melanoma cell response and resistance to the therapeutics used in the clinic, including inhibitors of BRAFmut and MEK1/2, and immunotherapy. In addition, the relationships between sensitivity to non-apoptotic cell death routes and specific cell phenotypes have been demonstrated, suggesting that plasticity of melanoma cells can be exploited to modulate response of these cells to different cell death stimuli. In this review, the current knowledge on the non-apoptotic cell death signaling pathways in melanoma cell biology and response to anti-cancer drugs has been discussed.
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Affiliation(s)
- Mariusz L Hartman
- Department of Molecular Biology of Cancer, Medical University of Lodz, 6/8 Mazowiecka Street, 92-215 Lodz, Poland
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Poduje S, Brozić JM, Prkačin I, Delaš Aždajić M, Goren A. Vemurafenib and cobimetinib‐induced toxic epidermal necrolysis in a patient with metastatic melanoma. Dermatol Ther 2019; 33:e13174. [DOI: 10.1111/dth.13174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Sanja Poduje
- Department of Dermatology and VenerologySestre milosrdnice University Hospital Center Zagreb Croatia
| | - Jasmina M. Brozić
- Department of Oncology and Nuclear MedicineSestre milosrdnice University Hospital Center Zagreb Croatia
| | - Ivana Prkačin
- Department of Dermatology and VenerologySestre milosrdnice University Hospital Center Zagreb Croatia
| | - Marija Delaš Aždajić
- Department of Dermatology and VenerologySestre milosrdnice University Hospital Center Zagreb Croatia
| | - Andy Goren
- Department of DermatologyApplied Biology, Inc. Irvine California
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Kaul S, Kaffenberger BH, Choi JN, Kwatra SG. Cutaneous Adverse Reactions of Anticancer Agents. Dermatol Clin 2019; 37:555-568. [DOI: 10.1016/j.det.2019.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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12
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Successful Treatment of Metastatic Adult Wilms Tumor With Anti-BRAF Treatment: A Case Report and a Brief Review of the Literature. Clin Genitourin Cancer 2019; 17:e721-e723. [DOI: 10.1016/j.clgc.2019.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/21/2019] [Indexed: 11/19/2022]
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13
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Luherne C, Darrigade AS, Dutriaux C, Prey S, Milpied B. Reintroduction of dabrafenib after previous vemurafenib-induced DRESS: Not always safe! JAAD Case Rep 2019; 5:422-423. [PMID: 31061867 PMCID: PMC6488678 DOI: 10.1016/j.jdcr.2019.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Camille Luherne
- Saint André Hospital, University Hospital Center of Bordeaux, Bordeaux, France
| | | | - Caroline Dutriaux
- Saint André Hospital, University Hospital Center of Bordeaux, Bordeaux, France
| | - Sorilla Prey
- Saint André Hospital, University Hospital Center of Bordeaux, Bordeaux, France
| | - Brigitte Milpied
- Saint André Hospital, University Hospital Center of Bordeaux, Bordeaux, France
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