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Avilés-Prieto J, Caro-Magdaleno M, Rodríguez-de-la-Rúa-Franch E. Peripheral Ulcerative Keratopathy following Systemic Treatment with Bortezomib: A Case Report. Ocul Immunol Inflamm 2024; 32:470-472. [PMID: 36780594 DOI: 10.1080/09273948.2023.2173241] [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: 03/22/2022] [Revised: 11/01/2022] [Accepted: 01/22/2023] [Indexed: 02/15/2023]
Abstract
A 60-year-old patient was diagnosed with multiple myeloma in November 2020, and started treatment in December 2020 with bortezomib, dexamethasone, and thalidomide. Four months later, he presented to the ophthalmology emergency department with inflammation and pain in the left eye. Examination of the anterior segment revealed severe, mixed anterior squamous blepharitis with significant bilateral palpebral inflammation, dysfunction of the meibomian glands, and several styes on both eyelids bilaterally. A peripheral ulcerative keratopathy was detected while examining the left eye cornea, with an inferior infiltrate and significant thinning, approximately 5 mm in length, at the limbal margin (Figure 1). Tear break-up time was shortened bilaterally. In addition to palpebral hygiene and oral treatment with doxycycline 100 mg every 24 hours, the patient was prescribed the following topical treatment without preservatives: artificial tears with lipid emulsion, netilmicin 0,3% 0,4 ml eye drops every 6 hours and dexamethasone 1 mg/ml every 8 hours.
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Affiliation(s)
- Javier Avilés-Prieto
- Department of Ophthalmology, University Hospital Virgen Macarena, Seville, Spain
| | - Manuel Caro-Magdaleno
- Department of Ophthalmology, University Hospital Virgen Macarena, Seville, Spain
- Members of RETICS OFTARED RD16/0008/0010 and RICORS FISS-21-RD21/0002/0011 (Inflammatory Diseases Network, Ocular Inflammatory Diseases, Ocular Surface Inflammatory Non Infectious Diseases, Instituto de Salud Carlos III)
- Department of Surgery, Ophthalmology Area, University of Seville, Seville, Spain
| | - Enrique Rodríguez-de-la-Rúa-Franch
- Department of Ophthalmology, University Hospital Virgen Macarena, Seville, Spain
- Members of RETICS OFTARED RD16/0008/0010 and RICORS FISS-21-RD21/0002/0011 (Inflammatory Diseases Network, Ocular Inflammatory Diseases, Ocular Surface Inflammatory Non Infectious Diseases, Instituto de Salud Carlos III)
- Department of Surgery, Ophthalmology Area, University of Seville, Seville, Spain
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2
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Wazalwar SS, Banpurkar AR, Perdih F. Synthesis, crystal structure and molecular docking study of novel isoxazole derivatives as CYP450 inhibitors in search of anticancer agents. J Biomol Struct Dyn 2023; 41:9476-9491. [PMID: 36350074 DOI: 10.1080/07391102.2022.2142667] [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: 12/03/2021] [Accepted: 10/27/2022] [Indexed: 11/11/2022]
Abstract
Synthesis of some novel isoxazole derivatives and their molecular docking with enzymes from CYP450 family carried out using erlotinib, gemcitabine and ketoconazole as reference drugs are reported in this work. Eight isoxazole derivatives of 3,4-substituted phenyl 3-chloroacrylaldehyde and one isoxazole derivative of cinnamaldehyde were synthesized. A molecular docking study of all nine compounds shows good docking score compared to standard drugs erlotinib, gemcitabine and ketoconazole. 4-OH and 4-F derivatives were found to have strong affinity for all six CYP450 proteins under study in the present work. 4-F and 3-NO2 derivatives could be a suitable lead compound inhibitor to CYP1A2 followed by 4-OH derivatives. 4-OH derivative with significant binding affinity showed encouraging inhibition of CYP1A2, CYP2C9, CYP2C8, CYP2C19 and CYP2D6. The current predictions over these nine isoxazole derivatives of 3,4-substituted phenyl 3-chloroacrylaldehyde will be needed to be further investigated in vivo and in vitro conditions to identify the optimum therapeutic efficacy. Synthesis of the isoxazole derivatives is the first known report of the Knoevenagal condensation of acrylaldehyde derivatives to form isoxazole derivatives as per the literature survey. A detailed crystal structure study of five analogues gives insight into the solid-state structural features of this new framework with isoxazole moieties.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Sachin Sudhakar Wazalwar
- Department of Applied Chemistry, Rajiv Gandhi College of Engineering, Research & Technology, Chandrapur, Maharashtra, India
| | - Anita Ravindra Banpurkar
- Department of Applied Chemistry, Rajiv Gandhi College of Engineering, Research & Technology, Chandrapur, Maharashtra, India
| | - Franc Perdih
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia
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3
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Han J, Owji S, Agarwal A, Kamat S, Luu Y, Mubasher A, Niedt G, Ray C, Cho HJ, Gulati N, Lamb A. Bortezomib-Induced Reticular Eruption in Patient with Multiple Myeloma. Dermatopathology (Basel) 2023; 10:226-230. [PMID: 37489455 PMCID: PMC10366922 DOI: 10.3390/dermatopathology10030031] [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: 05/25/2023] [Revised: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023] Open
Abstract
Bortezomib is the first proteasome inhibitor to treat a variety of malignancies and is currently part of the standard of care regimen for the initial treatment of patients with newly diagnosed multiple myeloma. While bortezomib is generally well tolerated, it has been associated with various side effects, which have limited its use in some patients. Here, we describe a unique case with histological confirmation of a reticular eruption that appeared at the site of a subcutaneous administration of bortezomib in a 62-year-old male who was newly diagnosed with IgG kappa multiple myeloma. A skin biopsy was performed, which revealed superficial perivascular dermatitis predominantly composed of lymphocytes with rare eosinophils. The patient was successfully treated with betamethasone dipropionate 0.05% cream. When consulted, dermatologists should advise the oncology team of multiple myeloma patients treated with bortezomib to maintain a high threshold before discontinuing the drug when a patient experiences an atypical, reticular rash following subcutaneous administration. Additionally, potent topical corticosteroids, such as betamethasone dipropionate 0.05% cream, should be considered in managing the cutaneous reticular eruptions related to bortezomib administration, in order to maintain an optimal treatment regimen for patients with multiple myeloma.
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Affiliation(s)
- Joseph Han
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Shayan Owji
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Aneesh Agarwal
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Samir Kamat
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yen Luu
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Adnan Mubasher
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - George Niedt
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Chloe Ray
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Hearn Jay Cho
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nicholas Gulati
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Angela Lamb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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4
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Petronek MS, Bayanbold K, Amegble K, Tomanek-Chalkley AM, Allen BG, Spitz DR, Bailey CK. Evaluating the iron chelator function of sirtinol in non-small cell lung cancer. Front Oncol 2023; 13:1185715. [PMID: 37397370 PMCID: PMC10313412 DOI: 10.3389/fonc.2023.1185715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
A distinctive feature of cancer is the upregulation of sirtuin proteins. Sirtuins are class III NAD+-dependent deacetylases involved in cellular processes such as proliferation and protection against oxidative stress. SIRTs 1 and 2 are also overexpressed in several types of cancers including non-small cell lung cancer (NSCLC). Sirtinol, a sirtuin (SIRT) 1 and 2 specific inhibitor, is a recent anti-cancer agent that is cytotoxic against several types of cancers including NSCLC. Thus, sirtuins 1 and 2 represent valuable targets for cancer therapy. Recent studies show that sirtinol functions as a tridentate iron chelator by binding Fe3+ with 3:1 stoichiometry. However, the biological consequences of this function remain unexplored. Consistent with preliminary literature, we show that sirtinol can deplete intracellular labile iron pools in both A549 and H1299 non-small cell lung cancer cells acutely. Interestingly, a temporal adaptive response occurs in A549 cells as sirtinol enhances transferrin receptor stability and represses ferritin heavy chain translation through impaired aconitase activity and apparent IRP1 activation. This effect was not observed in H1299 cells. Holo-transferrin supplementation significantly enhanced colony formation in A549 cells while increasing sirtinol toxicity. This effect was not observed in H1299 cells. The results highlight the fundamental genetic differences that may exist between H1299 and A549 cells and offer a novel mechanism of how sirtinol kills NSCLC cells.
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Affiliation(s)
- Michael S. Petronek
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA, United States
| | - Khaliunaa Bayanbold
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA, United States
| | - Koffi Amegble
- Department of Biology, Grinnell College, Grinnell, IA, United States
| | - Ann M. Tomanek-Chalkley
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA, United States
| | - Bryan G. Allen
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA, United States
| | - Douglas R. Spitz
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA, United States
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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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Gu S, Menzer C, Hay JL, Pena C, Dusza S, Lacouture ME, Markova A. PRO-CTCAE reveals under-recognition of dermatologic symptom burden in hospitalized cancer patients. Support Care Cancer 2023; 31:337. [PMID: 37183206 PMCID: PMC10547098 DOI: 10.1007/s00520-023-07793-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Dermatologic adverse events (dAEs) occur frequently in hospitalized patients and can significantly reduce quality of life. Physicians grade dAEs using the Common Terminology Criteria of Adverse Events (CTCAE). However, they often underestimate symptom frequency and severity. The patient-reported outcomes (PRO) version of the CTCAE (PRO-CTCAE) was developed to assess symptoms from the patient's perspective. In this study, we assessed the patient-reported burden of dAEs via the PRO-CTCAE questionnaire and compared results with dAE assessment by treating oncologists and dermatologists. METHODS Patients admitted to Memorial Sloan Kettering Cancer Center from 6/1/2018 to 4/30/2019 and received a dermatology consultation were eligible. Once enrolled, participants completed a PRO-CTCAE questionnaire on 14 dermatologic symptoms. CTCAE grades assigned by oncology and dermatology were obtained from clinical notes, and kappa statistics were calculated to evaluate the level of agreement between physician and patient evaluations. RESULTS A total of 100 patients (mean age 59.4, 55% male) were prospectively enrolled. The most common patient-reported dAEs were rash (72%), swelling (67%), pruritus (64%), bruising (53%), and hives (37%). Oncologists and dermatologists underreported dAEs except for rash (median kappa values 0.3 [0.02-0.84] and 0.32 [0.02-0.87], respectively). Oncologists and dermatologists were concordant with each other's documented assessment of dAEs (median kappa value 0.985 [0.55-1]). CONCLUSION Oncology patient-reported dAEs in a tertiary academic oncologic referral center were under-recognized by providers. PRO-CTCAE may be a useful tool to optimize inpatient dermatologic care for cancer patients by detecting and allowing management of patient-reported dAEs.
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Affiliation(s)
- Stephanie Gu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA
| | - Christian Menzer
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Camila Pena
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA
| | - Stephen Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA
- Department of Dermatology, Weill Cornell Medical College, New York, NY, USA
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 545 East 73rd Street, New York, NY, 10021, USA.
- Department of Dermatology, Weill Cornell Medical College, New York, NY, USA.
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Emvalomati A, Oflidou V, Papageorgiou C, Kemanetzi C, Giannouli M, Kalloniati E, Efthymiadis K, Koukoutzeli C, Timotheadou E, Trigoni A, Patsatsi A, Lazaridou E, Apalla Z, Trakatelli M. Narrative Review of Drug-Associated Nail Toxicities in Oncologic Patients. Dermatol Pract Concept 2023; 13:dpc.1301a64. [PMID: 36892360 PMCID: PMC9946059 DOI: 10.5826/dpc.1301a64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Nail toxicity represents one of the most common cutaneous adverse effects of both classic chemotherapeutic agents and new oncologic drugs, including targeted treatments and immunotherapy. OBJECTIVES We aimed to provide a comprehensive literature review of nail toxicities derived from conventional chemotherapeutic agents, targeted therapies (EGFR inhibitors, multikinase inhibitors, BRAF and MEK inhibitors) and immune checkpoint inhibitors (ICIs), including clinical presentation, implicated drugs and approaches for prevention and management. METHODS Retrieved literature from PubMed registry database was reviewed to include all articles published up to May 2021 relevant to the clinical presentation, diagnosis, incidence, prevention, and treatment of oncologic treatment-induced nail toxicity. The internet was searched for relevant studies. RESULTS A wide spectrum of nail toxicities is associated with both, conventional and newer anticancer agents. The frequency of nail involvement, especially with immunotherapy and new targeted agents remains unknown and patients with different cancer types receiving different regimens may develop the same nail disorder, whereas patients with the same type of cancer under the same chemotherapeutic treatment may develop different types of nail alterations. The underlying mechanisms of the varying individual susceptibility and the diverse nail responses to various anticancer treatments need further investigation. CONCLUSION Early recognition and treatment of nail toxicities can minimize their impact, allowing better adherence to conventional and newer oncologic treatments. Dermatologists, oncologists and other implicated physicians should be aware of these burdensome adverse effects in order to guide management and prevent impairment of patients' quality of life.
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Affiliation(s)
- Anastasia Emvalomati
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Valentina Oflidou
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Chryssoula Papageorgiou
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Christina Kemanetzi
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Maria Giannouli
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Evangelia Kalloniati
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Konstantinos Efthymiadis
- Department of Medical Oncology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Chrysanthi Koukoutzeli
- Department of Medical Oncology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Eleni Timotheadou
- Department of Medical Oncology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Anastasia Trigoni
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Aikaterini Patsatsi
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Elizabeth Lazaridou
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Zoe Apalla
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
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Del Pozzo-Magaña BR, Liy-Wong C. Drugs and the skin: A concise review of cutaneous adverse drug reactions. Br J Clin Pharmacol 2022. [PMID: 35974692 DOI: 10.1111/bcp.15490] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 01/19/2023] Open
Abstract
Drug-induced skin disease or cutaneous adverse drug reactions (CADRs) are terms that encompass the clinical manifestations of the skin, mucosae and adnexa induced by a drug or its metabolites. The skin is the organ most frequently affected by drug reactions, which may affect up to 10% of hospitalized patients and occur in 1-3% of multimedicated patients. Most CADRs are mild or self-resolving conditions; however, 2-6.7% of could develop into potentially life-threatening conditions. CADRs represent a heterogeneous field and can be diagnostically challenging as they may potentially mimic any dermatosis. Currently, there are between 29-35 different cutaneous drug-reaction patterns reported ranging from mild dermatitis to an extensively burnt patient. The most frequently reported are maculopapular rash, urticaria/angioedema, fixed drug eruption and erythema multiforme. Less common but more severe patterns include erythroderma, drug reaction with eosinophilia and systemic symptoms, and Stevens-Johnson syndrome/toxic epidermal necrolysis spectrum. Almost any drug can induce a CADR, but antibiotics, nonsteroidal anti-inflammatory drugs and antiepileptics are the most frequently involved. Different mechanisms are involved in the pathogenesis of CADRs, although in some cases, these remain still unknown. CADRs could be classified in different ways: (i) type A (augmented) or type B (bizarre); (ii) immediate or delayed; (iii) immune-mediated or nonimmune-mediated; (iv) nonsevere or life-threatening; and (v) by their phenotype, including exanthematous, urticarial, pustular and blistering morphology. Recognizing a specific CADR will mostly depend on the ability of the physician to perform a detailed clinical examination, the proper description of the morphology of the skin lesions and supporting laboratory and/or skin biopsy findings.
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Affiliation(s)
- Blanca R Del Pozzo-Magaña
- Department of Pediatrics, Division of Pediatric Clinical Pharmacology, Children's Hospital of Western Ontario, Western University, London, ON, Canada
| | - Carmen Liy-Wong
- Department of Pediatrics, Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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9
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Saadet ED, Tek I. Evaluation of chemotherapy-induced cutaneous side effects in cancer patients. Int J Dermatol 2022; 61:1519-1526. [PMID: 35867950 DOI: 10.1111/ijd.16361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 06/03/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cutaneous side effects are commonly seen in cancer chemotherapy. As new chemotherapy drugs are developed, the frequency and the diversity of these cutaneous side effects increase. For this reason, identification and management of these side effects are an important part of the treatment of cancer patients. This study aimed to investigate mucocutaneous side effects of conventional chemotherapy and targeted therapy agents that are used in cancer patients. METHODS In this cross-sectional study, 231 cancer patients, who received single or combination chemotherapy at the oncology department of our hospital between 2013 and 2020, were retrospectively reviewed, and mucocutaneous side effects we evaluated. RESULTS The ages of the patients varied between 27 and 90 years with a median age of 60 years. Of the patients, 136 (58.9%) were women, and 95 (41.1%) were men. Combination chemotherapy was applied to 174 patients (71.9%). Mucocutaneous side effects were present in 558 patients. The most common side effect was alopecia, which was observed in 158 patients (65.6%). This was followed by mucositis (39.4%), hand-foot syndrome (35.3%), papulopustular rash (22%), dermatitis (18.3%), xerosis (14.1%), nail disorders (12%), and others. CONCLUSIONS Although chemotherapy-induced cutaneous side effects are not usually life-threatening, they may lead to the development of morbidity and discontinuance or termination of the treatment. Therefore, these side effects should be well managed to improve the quality of life of cancer patients.
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Affiliation(s)
- Elif Demirci Saadet
- Department of Dermatology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ibrahim Tek
- Department of Medical Oncology, Medicana International Ankara Hospital, Ankara, Turkey
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10
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Chin CC, Shiau JP, Luo CW, Hou MF. Unilateral lower-limb vasculopathy: A rare adverse event of CDK4/6 inhibitor in breast cancer. Kaohsiung J Med Sci 2022; 38:494-495. [PMID: 35319159 DOI: 10.1002/kjm2.12526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/19/2022] [Accepted: 02/09/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Jun-Ping Shiau
- Division of Breast Oncology and Surgery, Department of Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Wen Luo
- Division of Breast Oncology and Surgery, Department of Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Feng Hou
- Division of Breast Oncology and Surgery, Department of Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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11
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Khoshnam-Rad N, Gheymati A, Jahangard-Rafsanjani Z. Tyrosine kinase inhibitors-associated pyoderma gangrenosum, a systematic review of published case reports. Anticancer Drugs 2022; 33:e1-e8. [PMID: 34282745 DOI: 10.1097/cad.0000000000001140] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pyoderma gangrenosum is a rare ulcerative dermatosis. It may be caused by some drugs, including small molecule tyrosine kinase inhibitors (TKIs). The aim of this study was to evaluate the reported evidence of pyoderma gangrenosum associated with the use of these drugs. A systematic electronic literature search of PubMed and Embase was conducted. In these databases, search terms describing pyoderma gangrenosum were combined with TKIs. Fifteen case reports (eight cases associated with sunitinib, two with imatinib, two with ibrutinib, one with gefitinib, one with pazopanib, and one with dabrafenib and trametinib) were identified over the 14 years. The average Naranjo score of these cases is 6.6, which indicates a probable adverse drug reaction. Pyoderma gangrenosum is a probable and reversible drug reaction associated with some TKIs. Detailed medical history can help to prompt diagnosis of drug-induced pyoderma gangrenosum. Clinicians should be aware of TKI-associated pyoderma gangrenosum when caring for the skin of oncologic patients undergoing therapy with kinase inhibitors.
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Affiliation(s)
| | - Azin Gheymati
- Department of Clinical Pharmacy, Faculty of Pharmacy
| | - Zahra Jahangard-Rafsanjani
- Department of Clinical Pharmacy, Faculty of Pharmacy
- Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran, Tehran, Iran
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12
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Liu LY, Teng JMC, Spunt SL, Strelo JL, Kwong BY, Zaba LC. Dermatologic toxicities of targeted antineoplastic agents and immune checkpoint inhibitor therapy in pediatric patients: A systematic review. Pediatr Blood Cancer 2021; 68:e29346. [PMID: 34569142 DOI: 10.1002/pbc.29346] [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: 01/12/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 11/09/2022]
Abstract
Cutaneous adverse events (cAEs) from targeted antineoplastic agents and immune checkpoint inhibitors are common in children with cancer and may lead to dose reduction or cessation of critical oncologic treatment. Timely diagnosis and proper management of cAEs in pediatric oncology patients is essential to optimize ongoing cancer-directed therapy and improve quality of life. This systematic review of published studies summarizes dermatologic toxicities to targeted anticancer treatments and immune checkpoint inhibitors.
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Affiliation(s)
- Lucy Y Liu
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Joyce M C Teng
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA.,Department of Dermatology, Division of Pediatric Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Sheri L Spunt
- Department of Pediatrics, Division of Hematology/Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Jenna L Strelo
- Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California, USA
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA.,Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California, USA
| | - Lisa C Zaba
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA.,Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California, USA
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13
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Abstract
PURPOSE To describe the timing of chemotherapy initiation after surgery for Wilms tumor (WT) and neuroblastoma within a dedicated children's cancer center. METHODS A single-institution retrospective cohort study identified patients that underwent resection of unilateral WT or high-risk neuroblastoma and received adjuvant chemotherapy treatment. Adjuvant chemotherapy initiation and postoperative complications were recorded. RESULTS Among 47 WT patients, the median time to chemotherapy initiation was 11 days [interquartile range IQR 7-14]. 3 WT patients had post-operative complications, but all preceded chemotherapy. Among 83 patients treated for high-risk neuroblastoma, the median time to chemotherapy was 11 days [IQR 9-14]. High-risk neuroblastoma patients with 30-day postoperative complications had a significantly longer time to initiation of adjuvant chemotherapy (odds ratio 1.13; p = 0.008). Many of these complications preceded and delayed the initiation of post-operative chemotherapy. No complications occurred in the group of 12 (25%) WT patients or 16 (19.3%) neuroblastoma patients who started chemotherapy ≤ 7 days after surgery. CONCLUSION There is no association between early initiation of adjuvant chemotherapy and post-operative complications including wound healing. Early initiation of chemotherapy (≤ 7 days) is feasible in unilateral WT or high-risk neuroblastoma patients who are otherwise doing well without resulting in a preponderance of wound healing complications.
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14
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Song Z, Tian F, Feng S, Shi L, Chen X, Liu X, Wang M, Qi Y, Hui T, Fu Y. Pegylated liposomal doxorubicin-induced hand-foot syndrome predicted by serum metabolomic profiling and prevented by calcium dobesilate. J Am Acad Dermatol 2021; 86:688-690. [PMID: 33684488 DOI: 10.1016/j.jaad.2021.02.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Zhenchuan Song
- Breast Center, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China.
| | - Fuguo Tian
- Breast Center, Shanxi Tumor Hospital, Taiyuan, China
| | - Shuo Feng
- Breast Center, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China
| | - Lingzi Shi
- Breast Center, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China
| | - Xiaoqing Chen
- Breast Center, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China
| | - Xiaohan Liu
- Breast Center, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China
| | - Meiqi Wang
- Breast Center, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China
| | - Yixin Qi
- Breast Center, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China
| | - Tianli Hui
- Breast Center, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China
| | - Yuming Fu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China; Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China.
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15
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Gisondi P, Geat D, Mattiucci A, Lombardo F, Santo A, Girolomoni G. Incidence of Adverse Cutaneous Reactions to Epidermal Growth Factor Receptor Inhibitors in Patients with Non-Small-Cell Lung Cancer. Dermatology 2021; 237:929-933. [PMID: 33508823 DOI: 10.1159/000513233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) inhibitors are routinely used in advanced non-small-cell lung cancer (NSCLC) harboring EGFR mutations. However, their use is associated with gastrointestinal and cutaneous toxicities, including acneiform eruptions, pruritus, xerosis, nail and hair changes. Aside from reducing patients' quality of life, such cutaneous reactions have a considerable impact on the oncologic treatment given that dose reduction or even drug discontinuation may be necessary, especially for the severe forms. OBJECTIVES To assess the incidence, impact on treatment and management of EGFR inhibitor-related cutaneous reactions in patients with NSCLC. METHODS We conducted a prospective observational study on 87 consecutive patients with advanced NSCLC treated with EGFR-tyrosine kinase inhibitors from January to December 2019. Patients who developed mucocutaneous reactions were evaluated and treated by both oncologists and dermatologists, and underwent dermatologic follow-up until resolution of the cutaneous reaction. Demographic and clinical data were collected for each patient, and the severity of the cutaneous reaction was graded using the Common Terminology Criteria for Adverse Events. RESULTS Seventy-one patients (81.6%) developed cutaneous reactions. The number of cutaneous reactions per patient was 1 in 37%, 2 in 41% and 3 or more in 22%. The most common cutaneous reactions included acneiform eruptions (56.3%), xerosis ± asteatotic eczema (48.3%), nail changes (39.1%), mucositis (29.9%), pruritus (24.1%) and hair changes (12.6%). Afatinib was associated with a higher rate of nail changes and mucositis (p < 0.01 and p < 0.005, respectively) compared to other agents, while no patient-related predictive factors were identified. Dose reduction was performed in 18% of patients. Multidisciplinary management involving dermatologists allowed to resume the drug in all patients who had discontinued it due to the cutaneous reactions. CONCLUSIONS A multidisciplinary approach to EGFR inhibitor-related cutaneous reactions is advantageous and can reduce the need to discontinue oncologic treatment.
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Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Davide Geat
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy,
| | - Alessandra Mattiucci
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Antonio Santo
- Medical Oncology, University of Verona, AOUI Verona, Verona, Italy.,Lung Unit, Ospedale P. Pederzoli of Peschiera del Garda, Peschiera del Garda, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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16
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Deutsch A, Leboeuf NR, Lacouture ME, McLellan BN. Dermatologic Adverse Events of Systemic Anticancer Therapies: Cytotoxic Chemotherapy, Targeted Therapy, and Immunotherapy. Am Soc Clin Oncol Educ Book 2021; 40:485-500. [PMID: 32421446 DOI: 10.1200/edbk_289911] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Over the past 2 decades, rapid advancement in systemic anticancer therapeutics has led to astounding improvement in survival rates of patients with cancer. However, this celebrated progress has brought with it an evolving spectrum of drug toxicities that limit their prodigious capabilities. Cutaneous adverse events are of the most frequent of these toxicities, with substantial impact on quality of life and commonly resulting in dose reduction or change in therapy. Thus, familiarity with the array of dermatologic manifestations caused by these drugs is prudent for patient treatment. As such, the advent of dedicated oncodermatologists, and their introduction into multidisciplinary cancer care, has been crucial in optimizing treatment through therapeutic achievement and overall well-being. This review will address the epidemiology, clinical presentations, and management strategies of the major dermatologic adverse events of systemic anticancer agents, including cytotoxic chemotherapy, targeted therapy, and immunotherapy.
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Affiliation(s)
- Alana Deutsch
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Nicole R Leboeuf
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Cutaneous Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Mario E Lacouture
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Beth N McLellan
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, NY
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17
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Wu J, Liu D, Offin M, Lezcano C, Torrisi JM, Brownstein S, Hyman DM, Gounder MM, Abida W, Drilon A, Harding JJ, Sullivan RJ, Janku F, Welsch D, Varterasian M, Groover A, Li BT, Lacouture ME. Characterization and management of ERK inhibitor associated dermatologic adverse events: analysis from a nonrandomized trial of ulixertinib for advanced cancers. Invest New Drugs 2021; 39:785-795. [PMID: 33389388 DOI: 10.1007/s10637-020-01035-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022]
Abstract
Background Ulixertinib is the first-in-class ERK1/2 kinase inhibitor with encouraging clinical activity in BRAF- and NRAS-mutant cancers. Dermatologic adverse events (dAEs) are common with ulixertinib, so management guidelines like those established for epidermal growth factor receptor inhibitor (EGFRi)-associated dAEs are needed. Patients and Methods This was an open-label, multicenter, phase I dose escalation and expansion trial of ulixertinib evaluating data from 135 patients with advanced malignancies enrolled between March 2013 and July 2017. Histopathological features, management, and dAEs in 34 patients are also reported. Twice daily oral ulixertinib was administered at 10 to 900 mg in the dose escalation cohort (n = 27) and at 600 mg in 21-day cycles in the expansion cohort (n = 108). Results The incidence of ulixertinib-induced dAEs and combined rash were 79% (107/135) and 76% (102/135). The most common dAEs included acneiform rash (45/135, 33%), maculopapular rash (36/135, 27%), and pruritus (34/135, 25%). Grade 3 dAEs were observed in 19% (25/135) of patients; no grade 4 or 5 dAEs were seen. The presence of at least 1 dAE was associated with stable disease (SD) or partial response (PR) (OR = 3.64, 95% CI 1.52-8.72; P = .003). Acneiform rash was associated with a PR (OR = 10.19, 95% CI 2.67-38.91; P < .001). Conclusion The clinical spectrum of ulixertinib-induced dAEs was similar to EGFR and MEK inhibitors; dAEs may serve as a surrogate marker of tumor response. We propose treatment algorithms for common ERK inhibitor-induced dAEs to maintain patients' quality of life and dose intensity for maximal clinical benefit. Clinical Trial Registration: NCT01781429.
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Affiliation(s)
- J Wu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Linkou, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - D Liu
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - M Offin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - C Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - J M Torrisi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - S Brownstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - D M Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - M M Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - W Abida
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - A Drilon
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA.,Thoracic Oncology and Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine, 530 East 74th Street, New York, NY, 10021, USA
| | - J J Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - R J Sullivan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, 02114, USA
| | - F Janku
- MD Anderson Cancer Center, The University of Texas, Houston, TX, 77030, USA
| | - D Welsch
- BioMed Valley Discoveries, Kansas City, MO, 64111, USA
| | - M Varterasian
- BioMed Valley Discoveries, Kansas City, MO, 64111, USA
| | - A Groover
- BioMed Valley Discoveries, Kansas City, MO, 64111, USA
| | - B T Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. .,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA. .,Thoracic Oncology and Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine, 530 East 74th Street, New York, NY, 10021, USA.
| | - M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. .,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. .,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine, 530 East 74th Street, New York, NY, 10021, USA.
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18
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Wang CJ, Brownell I. BRAF Inhibitors for the Treatment of Papulopustular Eruptions from MAPK Pathway Inhibitors. Am J Clin Dermatol 2020; 21:759-764. [PMID: 32720072 DOI: 10.1007/s40257-020-00539-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Inhibitors of the mitogen-activated protein kinase (MAPK) pathway are commonly used in clinical oncology. However, with the exception of BRAF inhibitors (BRAFi), MAPK pathway inhibitors such as epidermal growth factor receptor inhibitors (EGFRi) or MEK inhibitors (MEKi) are associated with dose-limiting papulopustular eruptions. Interestingly, patients treated with a combination of systemic BRAFi and MEKi experience less skin toxicities than patients on monotherapy BRAFi or MEKi. The reduction in cutaneous adverse events with combination therapy is thought to be due to a paradoxical activation of the MAPK pathway by BRAFi in keratinocytes carrying wildtype BRAF. Although treatment options for EGFRi- or MEKi-induced papulopustular eruptions exist, many patients still experience dose reduction, interruption, or discontinuation of EGFRi or MEKi. With the goal of activating MAPK signaling in the skin via BRAFi while minimizing systemic risks, we propose topical BRAFi therapy for the treatment and prevention of papulopustular eruptions due to MAPK pathway inhibitors. If effective, patients will be able to tolerate higher doses of MAPK pathway inhibitors, stay on treatment longer, and achieve better therapeutic outcomes overall.
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Affiliation(s)
- Catherine J Wang
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 10 Center Drive, 12N240C, Bethesda, MD, 20892-1908, USA
| | - Isaac Brownell
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 10 Center Drive, 12N240C, Bethesda, MD, 20892-1908, USA.
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19
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Çelik U, Aydemir EH, Engin B, Oba MÇ, Yılmaz M, Meşe ŞG. Dermatological side effects of immunotherapy drugs and targeted cancer therapies: Importance of dermatology and oncology collaboration. J Oncol Pharm Pract 2020; 27:1853-1860. [PMID: 33131448 DOI: 10.1177/1078155220970621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Novel anti-cancer drugs such as targeted cancer therapies and immune check-point inhibitors (ICIs) have adverse events, especially concerning the skin. The aim of this study is to report an overview of the commonly consulted dermatological side effects of ICIs and targeted cancer therapies in clinical practice, along with their management. METHODS In this single-center study, we evaluated consecutive oncological patients who were referred from the oncology outpatient clinic to the dermatology outpatient clinic due to skin side effects of ICIs and targeted therapies. All patients were examined and treated at the same day of referral by experienced dermatologists. Patient characteristics, clinical findings, diagnostic workups and treatments were retrieved from outpatient records. RESULTS Sixty three patients were enrolled. Most common diagnoses were lung carcinoma, melanoma and colon carcinoma. Fifty patients (79%) were using targeted therapies while 13 (21%) were using ICIs. Xerosis was the most common side effect (44%), followed by acneiform rash, paronychia, eczema and pruritus. Majority of the side effects were grade 2 and 3. Psoriasis was a common side effect of ICIs. One patient had a newly developed dysplastic nevus on vemurafenib treatment. Oncological treatment was not withheld in any of the patients. CONCLUSIONS This study revealed the most commonly consulted skin side effects of novel anti-cancer drugs and their management in daily practice. We underlie the importance of collaborative work of oncology and dermatology professionals as early management of cutaneous side effects of targeted therapies and ICIs improves patient outcomes.
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Affiliation(s)
- Uğur Çelik
- Department of Dermatology and Venerology, Cerrahpasa Medical Faculty, Istanbul University-Cerahpasa, Istanbul, Turkey
| | - Ertuğrul H Aydemir
- Department of Dermatology and Venerology, Cerrahpasa Medical Faculty, Istanbul University-Cerahpasa, Istanbul, Turkey
| | - Burhan Engin
- Department of Dermatology and Venerology, Cerrahpasa Medical Faculty, Istanbul University-Cerahpasa, Istanbul, Turkey
| | - Muazzez Ç Oba
- Department of Dermatology and Venerology, Cerrahpasa Medical Faculty, Istanbul University-Cerahpasa, Istanbul, Turkey
| | - Mesut Yılmaz
- Department of Medical Oncology, Cerrahpasa Medical Faculty, Istanbul University-Cerahpasa, Istanbul, Turkey
| | - Şermin Güven Meşe
- Department of Medical Oncology, Cerrahpasa Medical Faculty, Istanbul University-Cerahpasa, Istanbul, Turkey
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20
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Boull CL, Gardeen S, Abdali T, Li E, Potts J, Rubin N, Carlberg VM, Gupta D, Hunt R, Luu M, Maguiness SM, Moertel CL, Song H, Vivar KL, Coughlin C, Huang JT, Lara-Corrales I. Cutaneous reactions in children treated with MEK inhibitors, BRAF inhibitors, or combination therapy: A multicenter study. J Am Acad Dermatol 2020; 84:1554-1561. [PMID: 32682884 DOI: 10.1016/j.jaad.2020.07.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Treatment with BRAF inhibitors (BRAFI) and MEK inhibitors (MEKI) causes cutaneous reactions in children, limiting dosing or resulting in treatment cessation. The spectrum and severity of these reactions is not defined. OBJECTIVE To determine the frequency and spectrum of cutaneous reactions in children receiving BRAFI and MEKI and their effects on continued therapy. METHODS A multicenter, retrospective study was conducted at 11 clinical sites in the United States and Canada enrolling 99 children treated with BRAFI and/or MEKI for any indication from January 1, 2012, to January 1, 2018. RESULTS All children in this study had a cutaneous reaction; most had multiple, with a mean per patient of 3.5 reactions on BRAFI, 3.7 on MEKI, and 3.4 on combination BRAFI/MEKI. Three patients discontinued treatment because of a cutaneous reaction. Treatment was altered in 27% of patients on BRAFI, 39.5% on MEKI, and 33% on combination therapy. The cutaneous reactions most likely to alter treatment were dermatitis, panniculitis, and keratosis pilaris-like reactions for BRAFI and dermatitis, acneiform eruptions, and paronychia for MEKI. CONCLUSIONS Cutaneous reactions are common in children receiving BRAFI and MEKI, and many result in alterations or interruptions in oncologic therapy. Implementing preventative strategies at the start of therapy may minimize cutaneous reactions.
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Affiliation(s)
- Christina L Boull
- Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Edward Li
- Harvard Medical School, Boston, Massachusetts
| | - Jolee Potts
- Washington School of Medicine in St Louis, St. Louis, Missouri
| | - Nathan Rubin
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | | | - Deepti Gupta
- Seattle Children's Hospital, Seattle, Washington
| | | | - Minnelly Luu
- Children's Hospital Los Angeles, Los Angles, California
| | - Sheilagh M Maguiness
- Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Christopher L Moertel
- Division of Pediatric Hematology and Oncology, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Hannah Song
- Harvard Medical School, Boston, Massachusetts
| | - Karina L Vivar
- Division of Pediatric Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Carrie Coughlin
- Washington School of Medicine in St Louis, St. Louis, Missouri
| | - Jennifer T Huang
- Dermatology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Irene Lara-Corrales
- Division of Pediatric Medicine Section of Dermatology, University of Toronto, Toronto, Canada
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21
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Abstract
Drug reactions resulting from chemotherapy agents are common and frequently affect the skin. Although often benign, a select few of these cutaneous reactions may necessitate immediate changes to the antineoplastic regimens. Given the diversity of chemotherapeutic skin reactions and their complex implications on patient management, an organized conceptual schema is imperative for proper patient care. We evaluate a number of commonly seen chemotherapy-induced skin toxicities organized by pathogenic mechanism and drug class, providing a framework for the identification and categorization of adverse events to prevent unrecognition. Groupings of these reactions include direct cytotoxicity and/or drug accumulation, immunologic hypersensitivity, and aberrant molecular signaling.
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Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA.
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22
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Rizeq B, Gupta I, Ilesanmi J, AlSafran M, Rahman MDM, Ouhtit A. The Power of Phytochemicals Combination in Cancer Chemoprevention. J Cancer 2020; 11:4521-4533. [PMID: 32489469 PMCID: PMC7255361 DOI: 10.7150/jca.34374] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 12/03/2019] [Indexed: 12/25/2022] Open
Abstract
Conventional therapies for cancer treatment have posed many challenges, including toxicity, multidrug resistance and economic expenses. In contrast, complementary alternative medicine (CAM), employing phytochemicals have recently received increased attention owing to their capability to modulate a myriad of molecular mechanisms with a less toxic effect. Increasing evidence from preclinical and clinical studies suggest that phytochemicals can favorably modulate several signaling pathways involved in cancer development and progression. Combinations of phytochemicals promote cell death, inhibit cell proliferation and invasion, sensitize cancerous cells, and boost the immune system, thus making them striking alternatives in cancer therapy. We previously investigated the effect of six phytochemicals (Indol-3-Carbinol, Resveratrol, C-phycocyanin, Isoflavone, Curcumin and Quercetin), at their bioavailable levels on breast cancer cell lines and were compared to primary cell lines over a period of 6 days. This study showed the compounds had a synergestic effect in inhibiting cell proliferation, reducing cellular migration and invasion, inducing both cell cycle arrest and apoptosis. Despite the vast number of basic science and preclinical cancer studies involving phytochemicals, the number of CAM clinical trials in cancer treatment still remains nascent. In this review, we summarize findings from preclinical and clinical studies, including our work involving use of phytochemicals, individually as well as in combination and further discuss the potential of these phytochemicals to pave way to integrate CAM in primary health care.
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Affiliation(s)
- Balsam Rizeq
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
- Biomedical Research Center, Qatar University, Doha, Qatar
| | - Ishita Gupta
- College of Medicine, Qatar University, Doha, Qatar
| | - Josephine Ilesanmi
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Mohammed AlSafran
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - MD Mizanur Rahman
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Allal Ouhtit
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
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23
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Prediction of Side Effects Using Comprehensive Similarity Measures. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1357630. [PMID: 32190647 PMCID: PMC7064827 DOI: 10.1155/2020/1357630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/19/2020] [Accepted: 02/04/2020] [Indexed: 11/17/2022]
Abstract
Identifying the potential side effects of drugs is crucial in clinical trials in the pharmaceutical industry. The existing side effect prediction methods mainly focus on the chemical and biological properties of drugs. This study proposes a method that uses diverse information such as drug-drug interactions from DrugBank, drug-drug interactions from network, single nucleotide polymorphisms, and side effect anatomical hierarchy as well as chemical structures, indications, and targets. The proposed method is based on the assumption that properties used in drug repositioning studies could be utilized to predict side effects because the phenotypic expression of a side effect is similar to that of the disease. The prediction results using the proposed method showed a 3.5% improvement in the area under the curve (AUC) over that obtained when only chemical, indication, and target features were used. The random forest model delivered outstanding results for all combinations of feature types. Finally, after identifying candidate side effects of drugs using the proposed method, the following four popular drugs were discussed: (1) dasatinib, (2) sitagliptin, (3) vorinostat, and (4) clonidine.
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24
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Management of dermatologic adverse events from cancer therapies: recommendations of an expert panel. An Bras Dermatol 2020; 95:221-237. [PMID: 32165025 PMCID: PMC7175407 DOI: 10.1016/j.abd.2020.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/12/2020] [Indexed: 12/15/2022] Open
Abstract
With the development of new cancer therapies, systemic toxicity profile and effects on survival achieved an important improvement. However, a constellation of toxicities has emerged, even more remarkably, cutaneous adverse events. This report, developed by a board of Brazilian experts in oncodermatology, aims to establish a guideline for the dermatological care of oncologic patients. When possible, evidence-based recommendations were made, but in many cases, when strong evidence was not available, a consensus was reached, based on some data supporting therapies combined with personal experiences.
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Cabanillas ME, Ryder M, Jimenez C. Targeted Therapy for Advanced Thyroid Cancer: Kinase Inhibitors and Beyond. Endocr Rev 2019; 40:1573-1604. [PMID: 31322645 PMCID: PMC7341904 DOI: 10.1210/er.2019-00007] [Citation(s) in RCA: 176] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023]
Abstract
The treatment of advanced thyroid cancer has undergone rapid evolution in the last decade, with multiple kinase inhibitor drug approvals for each subtype of thyroid cancer and a number of other commercially available drugs that have been studied for this indication. Although most of the US Food and Drug Administration (FDA)-approved drugs are antiangiogenic multikinase inhibitors-vandetanib, cabozantinib, sorafenib, lenvatinib-there are two FDA indications that are mutation specific-dabrafenib/trametinib for BRAF-mutated anaplastic thyroid cancer and larotrectinib for NTRK-fusion thyroid cancer. Furthermore, other mutation-specific drugs, immunotherapies, and novel strategies for advanced thyroid cancer are under investigation. Understanding the molecular basis of thyroid cancer, the drugs of interest for treatment of advanced thyroid cancer, and how these drugs can be administered safely and in the appropriate clinical scenario are the topics of this review.
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Affiliation(s)
- Maria E Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mabel Ryder
- Department of Endocrinology and Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
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A technical appraisal of guidelines for the management of skin rash in patients on chemotherapy and targeted therapy. BMC Health Serv Res 2019; 19:704. [PMID: 31619221 PMCID: PMC6794896 DOI: 10.1186/s12913-019-4539-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/16/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Skin rash remains one of the most prevalent and troublesome clinical problems experienced by patients on chemotherapy and targeted therapy. To ensure high-quality care, guidelines are seen as the best guidance. Considering the quality of guidelines varies greatly, a systematical appraisal of the methodological quality of guidelines for the management of skin rash in patients on chemotherapeutic drugs and targeted anticancer therapies was undertaken, in order to identify appropriate ones for healthcare professionals. METHODS A systematic search of databases and Internet was conducted to obtain pertinent guidelines. Two reviewers independently assessed the eligibility of guidelines according to the inclusion criteria. Then the guidelines included were appraised by three researchers with the methodological quality of eligible guideline using Appraisal of Guidelines for Research and Evaluation II (AGREEII). RESULTS Totally nineteen guidelines met the inclusion criteria. The quality ranged from good to acceptable in scope and purpose (mean: 78.80%, range: 66.67-94.44%) and clarity of presentation domains (mean: 85.38%, 75.00-91.67%), but not in stakeholder involvement (mean: 50.15%, range: 36.11-75.00%), rigor of development (mean: 23.65%, range: 6.25-70.83%), applicability (mean: 23.96%, range: 4.17-52.08%), and editorial independence domains (mean: 45.18%, range: 0.00-87.50%). Overall, two guidelines were classified as "recommended". CONCLUSIONS Only two guidelines were recommended to manage skin rash in patients on chemotherapy and targeted therapies, most guidelines issued were of low to moderate quality. Thus, more attention should be paid to the methodological quality of guideline development in this field.
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Pignata I, Vicenzi G, Ravetto Enri L, Baratta F, Quaglino P, Comandone A, Ala A, Icardi M, Spadi R, Brusa P. The importance of a multidisciplinary care: community pharmacies as a hub to support oncologic patients with cutaneous reactions due to treatments. Ital J Dermatol Venerol 2019; 156:79-80. [PMID: 31525843 DOI: 10.23736/s2784-8671.19.06418-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Irene Pignata
- Department of Drug Science and Technology, University of Turin, Turin, Italy -
| | - Gaia Vicenzi
- Psychologist Psychotherapist Cognitive and Behavioral, Pavia, Italy
| | | | - Francesca Baratta
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | | | - Ada Ala
- Unit of Breast Surgery, Department of General and Specialistic Surgery, Città della Salute e della Scienza, Turin, Italy
| | - Massimiliano Icardi
- Second Medical Oncology Division, Città della Salute e della Scienza, Turin, Italy
| | - Rosella Spadi
- Department of Oncology, Medical Oncology Uno, Città della Salute e della Scienza, Turin, Italy
| | - Paola Brusa
- Department of Drug Science and Technology, University of Turin, Turin, Italy
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Kong D, Chen J, Sun X, Lin Y, Du Y, Huang D, Cheng H, He P, Yang L, Wu S, Zhao L, Meng X. GRIM-19 over-expression represses the proliferation and invasion of orthotopically implanted hepatocarcinoma tumors associated with downregulation of Stat3 signaling. Biosci Trends 2019; 13:342-350. [DOI: 10.5582/bst.2019.01185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Dexia Kong
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College
| | - Junyu Chen
- Department of Gynaecology and Obstetrics, Second Hospital of Jilin University
| | - Xun Sun
- Department of Gastroenterology, First Hospital of Jilin University
| | - Yan Lin
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College
| | - Yanwei Du
- Department of Pathophysiology, Basic Medicine School of Jilin University
| | - Di Huang
- Department of Pathophysiology, Basic Medicine School of Jilin University
| | - Hongjing Cheng
- Department of Gastroenterology, First Hospital of Jilin University
| | - Ping He
- Department of Gastroenterology, First Hospital of Jilin University
| | - Luoluo Yang
- Department of Gastroenterology, First Hospital of Jilin University
| | - Shan Wu
- Department of Gynaecology and Obstetrics, Second Hospital of Jilin University
| | - Lijing Zhao
- Department of Recovery, Nursing School of Jilin University
| | - Xiangwei Meng
- Department of Gastroenterology, First Hospital of Jilin University
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Chambelland A, Koeppel MC, Desmedt E, Fongue J, Buono JP, Berbis P, Delaporte E. [Nodulocystic eruption induced by sorafenib]. Ann Dermatol Venereol 2019; 146:646-654. [PMID: 31362839 DOI: 10.1016/j.annder.2019.06.002] [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: 06/10/2018] [Revised: 12/22/2018] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Sorafenib is a multikinase inhibitor used in the treatment of hepatocellular carcinoma, advanced renal cell carcinoma, and differentiated thyroid carcinoma. Cutaneous adverse events are numerous and occur frequently. PATIENTS AND METHODS We present two cases of nodulocystic lesions associated with comedones in patients treated with sorafenib for hepatocellular carcinoma. In the first patient, a 64-year-old man, lesions appeared on the trunk one year after beginning sorafenib. Histopathological examination revealed a non-granulomatous, perivascular and perisudoral polymorphic cellular infiltrate associated with comedones and microcysts. These lesions progressed via inflammatory episodes interrupted by long periods of spontaneous remission without any specific treatment. In the second patient, a 53-year-old woman, a rash appeared on the buttocks three months after starting sorafenib and then spread to the lumbar region and thighs. Histopathological examination was consistent with granulomatous acne lesions. The initial treatment (oral tetracycline and zinc) given for 3 months proved ineffective. Patient follow-up over 3 years showed gradual regression without the appearance of any further lesions. DISCUSSION In the literature, several reports discuss acneiform rashes in patients treated with targeted therapy. In most cases, these lesions were papulopustular without retentional lesions. There are few reports of nodulocystic eruptions associated with comedones following sorafenib therapy. The mechanisms of emergence of these lesions seem to involve inhibition of the RAF pathway, C-KIT, and the PDGF signaling pathway.
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Affiliation(s)
- A Chambelland
- Service de dermatologie, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France.
| | - M-C Koeppel
- Service de dermatologie, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
| | - E Desmedt
- Service de dermatologie, hôpital Claude-Huriez, CHRU, 59037 Lille, France
| | - J Fongue
- Service de dermatologie, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
| | - J-P Buono
- Service d'anatomie et cytologie pathologiques, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
| | - P Berbis
- Service de dermatologie, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
| | - E Delaporte
- Service de dermatologie, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
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30
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Synthesis and in vitro evaluation of substituted tetrahydroquinoline-isoxazole hybrids as anticancer agents. Med Chem Res 2019. [DOI: 10.1007/s00044-019-02363-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Abstract
Inflammatory skin diseases encompass a vast array of conditions. The field continues to expand and evolve with resurgence of conditions, through newly recognized medication adverse effects, and via more detailed descriptions of known dermatoses. The importance of clinicopathologic correlation and an up to date knowledge of dermatologic conditions cannot be overstated. This review focuses on an array of recent important developments in the histologic diagnosis of inflammatory conditions that affect the skin.
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Abstract
Targeted anticancer therapies have significantly increased the survival of patients with a variety of malignancies, improving tolerability and treatment duration. The increased lifespan and the expanded use of targeted agents have led to a variety of treatment-related adverse events. Pruritus, a common dermatologic adverse event with various incidences ranging from 2.2% to 47% across different categories of targeted anticancer therapies, has been overlooked. This article reviews the incidence, accompanying skin conditions, possible pathomechanism, and proposed management algorithms of pruritus associated with targeted therapies, including immunotherapies.
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Cubero DIG, Abdalla BMZ, Schoueri J, Lopes FI, Turke KC, Guzman J, Del Giglio A, Filho CDSM, Salzano V, Fabra DG. Cutaneous side effects of molecularly targeted therapies for the treatment of solid tumors. Drugs Context 2018; 7:212516. [PMID: 30038659 PMCID: PMC6052912 DOI: 10.7573/dic.212516] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 12/27/2022] Open
Abstract
Background Currently, molecularly targeted drugs are part of the therapeutic arsenal for the treatment of many neoplasms and are responsible for improvements in the quality of life and survival of patients. Although they act on proteins and components within biochemical pathways that are expressed to a greater extent in neoplastic cells, these drugs can also interfere with the activity of normal cells. Scope This article reviews the cutaneous side effects of main molecularly targeted cancer therapies for solid tumors. Findings The use of these drugs causes side effects, and the skin is one of the most commonly affected organs. In this literature review, we discuss the adverse cutaneous effects caused by molecularly targeted drugs. Conclusion The identification of these reactions is important to both dermatologists and oncologists so that they properly diagnose the reaction and administer adequate treatment, which would allow greater adherence to the oncological treatment and improve patients’ quality of life.
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Affiliation(s)
- Daniel I G Cubero
- Department of Oncology and Hematology, ABC Foundation School of Medicine, Av Principe de Gales, 821, Santo André/SP - Brazil, ZIP 09060-650
| | | | - Jean Schoueri
- ABC Foundation School of Medicine, Av Principe de Gales, 821, Santo André/SP - Brazil, ZIP 09060-650
| | - Fabio Iazetti Lopes
- ABC Foundation School of Medicine, Av Principe de Gales, 821, Santo André/SP - Brazil, ZIP 09060-650
| | - Karine Corcione Turke
- Department of Dermatology, ABC Foundation School of Medicine, Av Principe de Gales, 821, Santo André/SP - Brazil, ZIP 09060-650
| | - Jose Guzman
- Department of Dermatology, ABC Foundation School of Medicine, Av Principe de Gales, 821, Santo André/SP - Brazil, ZIP 09060-650
| | - Auro Del Giglio
- Department of Oncology and Hematology, ABC Foundation School of Medicine, Av Principe de Gales, 821, Santo André/SP - Brazil, ZIP 09060-650
| | | | - Vanessa Salzano
- Department of Dermatology, ABC Foundation School of Medicine, Av Principe de Gales, 821, Santo André/SP - Brazil, ZIP 09060-650
| | - Dolores Gonzalez Fabra
- Department of Dermatology, ABC Foundation School of Medicine, Av Principe de Gales, 821, Santo André/SP - Brazil, ZIP 09060-650
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Freites-Martinez A, Shapiro J, Goldfarb S, Nangia J, Jimenez JJ, Paus R, Lacouture ME. Hair disorders in patients with cancer. J Am Acad Dermatol 2018; 80:1179-1196. [PMID: 29660422 DOI: 10.1016/j.jaad.2018.03.055] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/07/2018] [Accepted: 03/18/2018] [Indexed: 01/04/2023]
Abstract
Cytotoxic chemotherapies, molecularly targeted therapies, immunotherapies, radiotherapy, stem cell transplants, and endocrine therapies may lead to hair disorders, including alopecia, hirsutism, hypertrichosis, and pigmentary and textural hair changes. The mechanisms underlying these changes are varied and remain incompletely understood, hampering the development of preventive or therapeutic guidelines. The psychosocial impact of chemotherapy-induced alopecia has been well documented primarily in the oncology literature; however, the effect of other alterations, such as radiation-induced alopecia, hirsutism, and changes in hair color or texture on quality of life have not been described. This article reviews clinically significant therapy-related hair disorders in oncology patients, including the underlying pathophysiological mechanisms, severity grading scales, patient-reported quality of life questionnaires, management strategies, and future translational research opportunities.
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Affiliation(s)
- Azael Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Shari Goldfarb
- Breast Cancer Medicine Service, Department of Medicine, Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julie Nangia
- Lester and Sue Smith Breast Center, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Joaquin J Jimenez
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida; Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ralf Paus
- Dermatology Research Centre, University of Manchester, Manchester, United Kingdom; National Institute of Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom; Department of Dermatology, University of Munster, Munster, Germany
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Affiliation(s)
- Kumpol Aiempanakit
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Zhuang W, Xie J, Zhou S, Zhou Z, Zhou Y, Sun X, Yuan X, Huang M, Liu S, Xin S, Su Q, Qiu H, Wang X. Can therapeutic drug monitoring increase the safety of Imatinib in GIST patients? Cancer Med 2018; 7:317-324. [PMID: 29316372 PMCID: PMC5806097 DOI: 10.1002/cam4.1286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/15/2017] [Accepted: 11/18/2017] [Indexed: 11/25/2022] Open
Abstract
Imatinib at 400 mg daily is the standard treatment for patients affected with CML and GIST. The intervariability in plasma concentration is very significant. In many reports, a good therapeutic effect is attributed to an adequate concentration of Imatinib. However, few studies have been conducted to investigate the association between plasma concentration and side effects. Besides, no upper concentration limit of Imatinib plasma concentration detection has been established. The correlation of Imatinib trough concentrations (Cmin ) with adverse effects (AEs) was described here. Plasma samples were obtained from patients after 3 months treatment with Imatinib (steady state, n = 122). Liquid chromatography/ tandem mass spectrometry was used to determine the concentration of Imatinib and its metabolite NDI. The incidence of myelosuppression was increased significantly with the increased Imatinib trough plasma concentration. The plasma level of Imatinib and NDI in patients who developed myelosuppression are 1698.3 ± 598.6 ng/mL and 242.1 ng/mL, respectively, which were significantly higher than those in patients who did not (1327.2 ± 623.4 ng/mL, P = 1.75 × 10-4 ; 206.3 ng/mL, P = 0.006). Estimated exposure thresholds of Imatinib and NDI were 1451.6 ng/mL with ROCAUC (95%CI) of 0.693 (0.597-0.789) and 207.1 ng/mL with ROCAUC (95%CI) of 0.646 (0.546-0.745), respectively. Multivariate regression confirmed the correlation of Imatinib Cmin with myelosuppression. Other side effects such as fluid retention and rash were not found to be correlated with Imatinib concentrations. These results suggest that trough concentration of Imatinib should be taken into consideration to increase the safety of Imatinib therapy in GIST patients.
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Affiliation(s)
- Wei Zhuang
- Institute of Clinical PharmacologySchool of Pharmaceutical SciencesSun Yat‐Sen UniversityGuangzhou510006China
| | - Jing‐Dun Xie
- State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐Sen University Cancer CenterGuangzhou510060China
| | - Shan Zhou
- Institute of Clinical PharmacologySchool of Pharmaceutical SciencesSun Yat‐Sen UniversityGuangzhou510006China
| | - Zhi‐Wei Zhou
- State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐Sen University Cancer CenterGuangzhou510060China
| | - Yi Zhou
- The first affiliated hospitalSun Yat‐Sen UniversityGuangzhou510080China
| | - Xiao‐Wei Sun
- State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐Sen University Cancer CenterGuangzhou510060China
| | - Xiu‐Hong Yuan
- State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐Sen University Cancer CenterGuangzhou510060China
| | - Min Huang
- Institute of Clinical PharmacologySchool of Pharmaceutical SciencesSun Yat‐Sen UniversityGuangzhou510006China
| | - Si Liu
- Institute of Clinical PharmacologySchool of Pharmaceutical SciencesSun Yat‐Sen UniversityGuangzhou510006China
| | - Shuang Xin
- Institute of Clinical PharmacologySchool of Pharmaceutical SciencesSun Yat‐Sen UniversityGuangzhou510006China
- State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐Sen University Cancer CenterGuangzhou510060China
| | - Qi‐Biao Su
- College of health scienceGuangdong Pharmaceutical UniversityGuangzhouGuangzhou510006China
| | - Hai‐Bo Qiu
- State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐Sen University Cancer CenterGuangzhou510060China
| | - Xue‐Ding Wang
- Institute of Clinical PharmacologySchool of Pharmaceutical SciencesSun Yat‐Sen UniversityGuangzhou510006China
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Wound healing complications in oncological patients: perspectives for cellular therapy. Postepy Dermatol Alergol 2018; 36:139-146. [PMID: 31320845 PMCID: PMC6627262 DOI: 10.5114/ada.2018.72585] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/23/2017] [Indexed: 12/16/2022] Open
Abstract
Various types of cancer are nowadays a serious medical and social problem and a great challenge for modern medicine. The majority of anticancer therapy is based on traditional chemotherapy and radiotherapy. Both of these highly non-specific types of treatment have a number of serious side effects including wound healing complications. Radiotherapy and chemotherapy mostly affect rapidly dividing skin cells (e.g. keratinocytes), as well as fibroblasts, melanocytes, endothelial and immune cells. Currently, there are many strategies to improve wound healing in oncological patients, including various types of dressings, biomaterials, growth factors, and cell therapies.
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Yagasaki K, Komatsu H, Soejima K, Naoki K, Kawada I, Yasuda H, Hamamoto Y. Targeted Therapy-induced Facial Skin Toxicities: Impact on Quality of Life in Cancer Patients. Asia Pac J Oncol Nurs 2018; 5:172-177. [PMID: 29607377 PMCID: PMC5863426 DOI: 10.4103/apjon.apjon_74_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objective: Targeted therapy-induced facial skin toxicities may reduce overall quality of life (QoL) in cancer patients. We investigated whether facial skin toxicities affect QoL and attempted to identify factors related to QoL in patients with advanced/recurrent cancer. Methods: We performed a cross-sectional study in 34 outpatients with advanced/recurrent cancer showing targeted therapy-induced facial skin toxicities in Japan between November 2016 and February 2017. For measurement, we used the Kessler Psychological Distress Scale (K6), Mental Adjustment to Cancer (MAC) Scale, and Dermatology Life Quality Index (DLQI). Data were analyzed using Spearman's rank correlation coefficient. Results: Mean DLQI score in 34 patients was 4.59 (standard deviation ± 4.70), which was interpreted as a small effect on a patient's life. Acneiform rash was the most common skin condition noted, followed by xerosis, pruritus, and erythema. Analysis of DLQI scores revealed that symptoms and feelings was the domain most commonly affected among different domains constituting the DLQI. MAC analysis revealed that the fighting spirit score was the highest among MAC scales. We found that age, K6, and fatalism construct in MAC were significantly correlated with total DLQI scores (age: Spearman's ρ= −0.48, P = 0.004; K6: ρ= 0.58, P < 0.001; fatalism; ρ= −0.39, P = 0.025). Conclusions: This is the first study investigating targeted therapy-induced facial skin toxicities in cancer patients. Our results suggest potential negative effects of facial skin toxicities on overall QoL in patients with advanced/recurrent cancer in middle and early old age.
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Affiliation(s)
- Kaori Yagasaki
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
| | - Hiroko Komatsu
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
| | - Kenzo Soejima
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Katsuhiko Naoki
- Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasuo Hamamoto
- Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan
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The incidence and management of cutaneous adverse events of the epidermal growth factor receptor inhibitors. Postepy Dermatol Alergol 2017; 34:418-428. [PMID: 29507555 PMCID: PMC5831275 DOI: 10.5114/ada.2017.71106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/27/2016] [Indexed: 01/04/2023] Open
Abstract
Overexpression of the epidermal growth factor receptor (EGFR) is found in many cancers, including those of the head and neck area, non-small-cell lung cancer, and colorectal, cervical, prostate, breast, ovary, stomach, and pancreatic cancer. The EGFR inhibitors are used at present in the treatment of such cancers. Skin lesions that develop during and after cancer treatment may be due to specific cytostatics, molecular-targeted drugs, radiation therapy, complementary therapy, or the cancer itself, and hence knowledge is essential to distinguish between them. The mechanism through which skin toxicity arises during treatment with EGFR inhibitors is not well known, but seems to be due to the modification of the RAS/RAF/MEK/ERK signal path associated with its activation, which results in the similarity between the adverse effects of EGFR inhibitors and the treatment of melanoma with BRAF and MEK inhibitors. The most common side effects are pruritus, xerosis, papulopustular rash, hand-foot skin reaction, alopecia and dystrophy of the hair, and paronychia. This work presents options for prevention and suggestions for managing these adverse events, which are of importance in the care of patients undergoing oncological treatment.
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Roman JW, Ojemuyiwa MA, Cordes LM, Madan RA, Sperling L. Docetaxel extravasation: Pathologic correlation and treatment with intralesional steroids. JAAD Case Rep 2017; 3:322-325. [PMID: 28752121 PMCID: PMC5518152 DOI: 10.1016/j.jdcr.2017.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- John W. Roman
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, Maryland
- Correspondence to: John W. Roman, MD, 22 Grove Ridge Ct, North Bethesda, MD 20852.22 Grove Ridge CtNorth BethesdaMD20852
| | - Michelle A. Ojemuyiwa
- Department of Hematology/Oncology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Lisa M. Cordes
- National Institutes of Health, Clinical Center Pharmacy Department, Bethesda, Maryland
| | - Ravi A. Madan
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Leonard Sperling
- Department of Dermatology and Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Zhu H, Zhu Z, Huang W, Cheng X, He J, Xiong C, Han J. Common and uncommon adverse cutaneous reactions to erlotinib: a study of 20 Chinese patients with cancer. Cutan Ocul Toxicol 2017; 37:96-99. [PMID: 28707485 DOI: 10.1080/15569527.2017.1355316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study presented common lesions with systemic toxicities and uncommon adverse cutaneous reactions such as anaphylactic dermatitis in patients undergoing treatment with erlotinib for the benefit of practicing dermatologists and oncologists. METHODS Adverse cutaneous reactions associated with erlotinib were reported in 20 Chinese patients with cancer. RESULTS Adverse cutaneous reactions reported included six cases of anaphylactic dermatitis, 12 cases of acneiform rash, nine cases of xerosis, five cases of nail changes and four cases of hair changes. One case of anaphylactic dermatitis manifested as erythema with swelling on the face and neck, and others as erosive and scaly erythema on the fold of skin, or red macules, papules, plaques and pigmentation on the whole body. Clinical details indicated anaphylactic reactions, including a high percentage of eosinophils in the peripheral blood, eosinophilic infiltration in the dermis layer and good response to antihistamines and topical steroids. Systemic toxicities accompanied by cutaneous reactions occurred in five patients including one case of anaphylactic dermatitis and four cases of acneiform rash. Elevated hepatic enzymes were observed among all the patients with grade-3 or grade-4 acneiform rashes. One patient with anaphylactic dermatitis and one with acneiform rash discontinued erlotinib administration due to severe lesions, high fever or severe elevation of hepatic enzymes. CONCLUSIONS Anaphylactic cutaneous reactions caused by erlotinib are rarely described hitherto. Systemic toxicities should be emphasized especially in cases with severe skin disorders. Timely detection and appropriate early intervention in patients who develop severe cutaneous reaction while on erlotinib therapy should be considered clinically.
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Affiliation(s)
- Huiling Zhu
- a Department of Dermatology , the First Affiliated Hospital of Guangzhou Medical University , Guangzhou , P. R. China
| | - Zhe Zhu
- b Department of Stem Cell Biology and Regenerative Medicine , Lerner Research Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Weining Huang
- a Department of Dermatology , the First Affiliated Hospital of Guangzhou Medical University , Guangzhou , P. R. China
| | - Xiping Cheng
- a Department of Dermatology , the First Affiliated Hospital of Guangzhou Medical University , Guangzhou , P. R. China
| | - Jiaxi He
- c Department of Thoracic Surgery , the First Affiliated Hospital of Guangzhou Medical University , Guangzhou , P. R. China
| | - Chunping Xiong
- a Department of Dermatology , the First Affiliated Hospital of Guangzhou Medical University , Guangzhou , P. R. China
| | - Jiande Han
- d Department of Dermatology , the First Affiliated Hospital of Sun Yat-sen University , Guangzhou , P. R. China
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Ransohoff JD, Kwong BY. Cutaneous Adverse Events of Targeted Therapies for Hematolymphoid Malignancies. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:834-851. [PMID: 28918995 DOI: 10.1016/j.clml.2017.07.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/10/2017] [Indexed: 12/11/2022]
Abstract
The identification of oncogenic drivers of liquid tumors has led to the rapid development of targeted agents with distinct cutaneous adverse event (AE) profiles. The diagnosis and management of these skin toxicities has motivated a novel partnership between dermatologists and oncologists in developing supportive oncodermatology clinics. In this article we review the current state of knowledge of clinical presentation, mechanisms, and management of the most common and significant cutaneous AEs observed during treatment with targeted therapies for hematologic and lymphoid malignancies. We systematically review according to drug-targeting pathway the cutaneous AE profiles of these drugs, and offer insight when possible into whether pharmacologic target versus immunologic modulation primarily underlie presentation. We include discussion of tyrosine kinase inhibitors (imatinib, dasatinib, nilotinib, bosutinib, ponatinib), blinatumomab, ibrutinib, idelalisib, anti-B cell antibodies (rituximab, ibritumomab, obinutuzumab, ofatumumab, tositumomab), immune checkpoint inhibitors (nivolumab, pembrolizumab), alemtuzumab, brentuximab, and proteasome inhibitors (bortezomib, carfilzomib, ixazomib). We highlight skin reactions seen with antiliquid but not solid tumor agents, draw attention to serious cutaneous AEs that might require therapy modification or cessation, and offer management strategies to permit treatment tolerability. We emphasize the importance of early diagnosis and treatment to minimize disruptions to care, optimize prognosis and quality of life, and promptly address life-threatening skin or infectious events. This evolving partnership between oncologists and dermatologists in the iterative characterization and management of skin toxicities will contribute to a better understanding of these drugs' cutaneous targets and improved patient care.
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Affiliation(s)
- Julia D Ransohoff
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA.
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Sorafenib-induced Acute Generalized Exanthematous Pustulosis: An Increasing Association? ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sorafenib-induced Acute Generalized Exanthematous Pustulosis: An Increasing Association? ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:599-601. [PMID: 28262110 DOI: 10.1016/j.ad.2016.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 11/22/2022] Open
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Oral mucosal changes induced by anticancer targeted therapies and immune checkpoint inhibitors. Support Care Cancer 2017; 25:1713-1739. [PMID: 28224235 DOI: 10.1007/s00520-017-3629-4] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/06/2017] [Indexed: 12/26/2022]
Abstract
Development of biological targeted therapies and immune checkpoint inhibitors has redefined the treatment for many cancers; however, the increasing use of new protocols has led to physicians observing a new spectrum of toxicities. To date, oral adverse events induced by these new anticancer therapies have been mainly reported using nonspecific terminology ("stomatitis," "mucosal inflammation," "mucositis") and remain poorly characterized, with the exception of mammalian target of rapamycin (mTOR) inhibitor-associated stomatitis. Oral toxicities of targeted therapies often display very characteristic features which clearly differ from classic oral injuries observed with cytotoxic chemotherapy and/or radiotherapy. In addition, they frequently affect more than 20% of treated patients and can lead to a significant morbidity or permanent treatment discontinuation. Oral mucosal toxicities described in this review include mTOR inhibitor-associated stomatitis (mIAS); stomatitis, benign migratory glossitis, and osteonecrosis of the jaw associated with multi-targeted kinase inhibitors of the VEGF and PDGF receptors; mucositis induced by EGFR inhibitors (in monotherapy or in combination with head and neck radiotherapy and/or chemotherapy); hyperkeratotic lesions with BRAF inhibitors; pigmentary changes and lichenoid reactions secondary to imatinib; and more recent data on the "Osler-Weber-Rendu-like syndrome" described with the antibody-drug conjugate, TDM-1. Finally, we provide, to our knowledge, the first available structured data on oral toxicities induced by the new recently FDA- and EMA-approved monoclonal antibodies targeting PD-1. Clinical management of these targeted therapy-related oral changes is also discussed.
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Millsop JW, Sharon VR, Petukhova T, Fung MA, Kiuru M. Chemotherapy reaction induced by ixabepilone, a microtubule stabilizing agent, mimicking extramammary Paget's disease in a patient with breast carcinoma. J Cutan Pathol 2016; 43:1215-1219. [PMID: 27686876 DOI: 10.1111/cup.12833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 12/31/2022]
Abstract
The histopathologic characteristics of reactions caused by the many novel anticancer agents are under-recognized. We report a case of a 67-year-old female with locally advanced metastatic breast cancer, who initially presented with an extensive reticulated erythematous patch on the trunk caused by intravascular metastases confirmed by a skin biopsy. Owing to disease progression, she was started on ixabepilone, a mitotic inhibitor. While receiving ixabepilone, another skin biopsy was obtained and initially interpreted as extramammary Paget's disease. However, the biopsy showed metaphase arrest of numerous keratinocytes in the basilar and suprabasilar epidermis. Atypical epithelial cells were only present in the intravascular spaces similar to the initial biopsy. Given the temporal association between the initiation of ixabepilone therapy and the epidermal mitotic arrest, a diagnosis of chemotherapy reaction to ixabepilone was rendered. Ixabepilone is an analog of epothilone, a microtubule stabilizer causing mitotic arrest of the cell cycle approved for the treatment of metastatic and locally advanced treatment-resistant breast cancer. The demonstration of epidermal mitotic arrest caused by ixabepilone is without precedent. The case emphasizes the importance of considering a chemotherapy reaction in the histologic differential diagnosis of epidermal mitotic arrest in a cancer patient receiving chemotherapy.
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Affiliation(s)
| | | | | | - Maxwell A Fung
- Department of Dermatology, University of California, Davis, CA, USA.,Department of Pathology, University of California, Davis, CA, USA
| | - Maija Kiuru
- Department of Dermatology, University of California, Davis, CA, USA.,Department of Pathology, University of California, Davis, CA, USA
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Caccavale S, Ruocco E. Acral manifestations of systemic diseases: Drug-induced and infectious diseases. Clin Dermatol 2016; 35:55-63. [PMID: 27938813 DOI: 10.1016/j.clindermatol.2016.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Drug reactions and systemic diseases often involve the skin. In particular, most drug-induced reactions and many infectious diseases present with dermatologic manifestations localized acrally, that is on distal portions of limbs (hand, foot) and head (ears, nose). A detailed review of all acral dermatologic signs of drug reactions and systemic diseases is beyond the scope of this paper, although some of these disorders will be discussed specifically here.
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Affiliation(s)
- Stefano Caccavale
- Department of Dermatology, Second University of Naples, Naples, Italy.
| | - Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
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Pugliese SB, Neal JW, Kwong BY. Management of Dermatologic Complications of Lung Cancer Therapies. Curr Treat Options Oncol 2016; 16:50. [PMID: 26338208 DOI: 10.1007/s11864-015-0368-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OPINION STATEMENT In recent years, oncogene-directed targeted agents and immunotherapies have expanded the treatment armamentarium for advanced lung cancer and, in particular, non-small cell lung cancer (NSCLC). Along with extended survival, these agents are accompanied by a host of cutaneous complications that affect the skin, hair, and nails. These skin complications range from the well-characterized papulopustular (acneiform) eruption of the epidermal growth factor receptor (EGFR) inhibitors to the emerging characterization of lichenoid skin eruptions seen during treatment with antibodies targeting the programmed cell death protein 1 (PD-1) and programmed cell death protein 1 ligand (PD-L1). When promptly recognized and accurately diagnosed, most cutaneous adverse events can be managed with supportive treatments, avoiding the need to interrupt antitumor therapy. Furthermore, preemptive management of skin problems can lead to significantly decreased severity of many cutaneous complications of these therapies. We encourage close collaboration between dermatologists and oncologists to better characterize cutaneous toxicity, select appropriate management, and avoid unnecessary dose reduction or discontinuation while simultaneously improving patient quality of life.
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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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Abstract
PURPOSE OF REVIEW Population ageing is a worldwide phenomenon. The presence of multiple comorbidities, polypharmacy, age-related changes in pharmacokinetics and pharmacodynamics, as well as skin changes in the elderly contribute to a unique diagnostic and management problem. This article reviews the epidemiology of cutaneous adverse drug reactions in the elderly and elaborates on a few specific types of reactions which are more relevant to the elderly. RECENT FINDINGS Chronic dermatoses, for example, eczema, have been reported to be associated with the use of long-term medications such as calcium channel blockers and hydrochlorothiazide. Elderly patients receiving treatment for cancers may develop chemotherapy-related cutaneous side effects, including those associated with newer 'targeted' molecular therapies. Elderly patients who develop severe cutaneous adverse drug reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, have worse prognosis in terms of mortality. SUMMARY Persons of advanced age often have multiple comorbidities and are on multiple medications. This can result in higher probability of an elderly person developing drug eruptions. It is important for the clinician to be aware of the range of drug-related eruptions and their implications.
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