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Davis AE, Kennelley GE, Amaye-Obu T, Jowdy PF, Ghadersohi S, Nasir-Moin M, Paragh G, Berman HA, Huss WJ. The phenomenon of phototoxicity and long-term risks of commonly prescribed and structurally diverse drugs. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY 2024; 19:100221. [PMID: 38389933 PMCID: PMC10883358 DOI: 10.1016/j.jpap.2023.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Photosensitivity to structurally diverse drugs is a common but under-reported adverse cutaneous reaction and can be classified as phototoxic or photoallergic. Phototoxic reactions occur when the skin is exposed to sunlight after administering topical or systemic medications that exhibit photosensitizing activity. These reactions depend on the dose of medication, degree of exposure to ultraviolet light, type of ultraviolet light, and sufficient skin distribution volume. Accurate prediction of the incidence and phototoxic response severity is challenging due to a paucity of literature, suggesting that phototoxicity may be more frequent than reported. This paper reports an extensive literature review on phototoxic drugs; the review employed pre-determined search criteria that included meta-analyses, systematic reviews, literature reviews, and case reports freely available in full text. Additional reports were identified from reference sections that contributed to the understanding of phototoxicity. The following drugs and/or drug classes are discussed: amiodarone, voriconazole, chlorpromazine, doxycycline, fluoroquinolones, hydrochlorothiazide, nonsteroidal anti-inflammatory drugs, and vemurafenib. In reviewing phototoxic skin reactions, this review highlights drug molecular structures, their reactive pathways, and, as there is a growing association between photosensitizing drugs and the increasing incidence of skin cancer, the consequential long-term implications of photocarcinogenesis.
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Affiliation(s)
- Anna E Davis
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gabrielle E Kennelley
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- College of Medicine, Central Michigan University, Mt. Pleasant, MI 48858, USA
| | - Tatiana Amaye-Obu
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Peter F Jowdy
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Sarah Ghadersohi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Mehr Nasir-Moin
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gyorgy Paragh
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Harvey A Berman
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Romanell Center for the Philosophy of Medicine and Bioethics, Park Hall University at Buffalo, Buffalo, NY 14260, USA
| | - Wendy J Huss
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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2
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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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3
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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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Deutsch A, Balagula Y, McLellan BN. Anticancer therapies associated with secondary cutaneous malignancies: A review of the literature. J Am Acad Dermatol 2020; 83:1425-1433. [DOI: 10.1016/j.jaad.2020.04.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/03/2020] [Accepted: 04/15/2020] [Indexed: 12/22/2022]
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5
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Hoorens MWH, Ourailidou ME, Rodat T, van der Wouden PE, Kobauri P, Kriegs M, Peifer C, Feringa BL, Dekker FJ, Szymanski W. Light-controlled inhibition of BRAFV600E kinase. Eur J Med Chem 2019; 179:133-146. [PMID: 31252305 DOI: 10.1016/j.ejmech.2019.06.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/22/2019] [Accepted: 06/15/2019] [Indexed: 11/26/2022]
Abstract
Metastatic melanoma is amongst the most difficult types of cancer to treat, with current therapies mainly relying on the inhibition of the BRAFV600E mutant kinase. However, systemic inhibition of BRAF by small molecule drugs in cancer patients results - paradoxically - in increased wild-type BRAF activity in healthy tissue, causing side-effects and even the formation of new tumors. Here we show the development of BRAFV600E kinase inhibitors of which the activity can be switched on and off reversibly with light, offering the possibility to overcome problems of systemic drug activity by selectively activating the drug at the desired site of action. Based on a known inhibitor, eight photoswitchable effectors containing an azobenzene photoswitch were designed, synthesized and evaluated. The most promising inhibitor showed an approximately 10-fold increase in activity upon light-activation. This research offers inspiration for the development of therapies for metastatic melanoma in which tumor tissue is treated with an active BRAFV600E inhibitor with high spatial and temporal resolution, thus limiting the damage to other tissues.
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Affiliation(s)
- Mark W H Hoorens
- University Medical Center Groningen, Department of Radiology, Medical Imaging Center, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands; Stratingh Institute for Chemistry, Faculty of Science and Engineering, University of Groningen, Nijenborgh 7, 9747 AG Groningen, Netherlands
| | - Maria E Ourailidou
- Department of Chemical and Pharmaceutical Biology, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, Netherlands
| | - Theo Rodat
- Institute of Pharmacy, Christian-Albrechts-University of Kiel, Gutenbergstr. 76, 24118 Kiel, Germany
| | - Petra E van der Wouden
- Department of Chemical and Pharmaceutical Biology, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, Netherlands
| | - Piermichele Kobauri
- Stratingh Institute for Chemistry, Faculty of Science and Engineering, University of Groningen, Nijenborgh 7, 9747 AG Groningen, Netherlands
| | - Malte Kriegs
- Laboratory of Radiobiology & Experimental Radiooncology and UCCH Kinomics Core Facility, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Christian Peifer
- Institute of Pharmacy, Christian-Albrechts-University of Kiel, Gutenbergstr. 76, 24118 Kiel, Germany
| | - Ben L Feringa
- Stratingh Institute for Chemistry, Faculty of Science and Engineering, University of Groningen, Nijenborgh 7, 9747 AG Groningen, Netherlands
| | - Frank J Dekker
- Department of Chemical and Pharmaceutical Biology, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, Netherlands
| | - Wiktor Szymanski
- University Medical Center Groningen, Department of Radiology, Medical Imaging Center, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands; Stratingh Institute for Chemistry, Faculty of Science and Engineering, University of Groningen, Nijenborgh 7, 9747 AG Groningen, Netherlands.
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Buckley B, Pierce B. Targeted inhibition of the BRAF pathway in a patient with stage IV melanoma. JAAPA 2018; 31:24-26. [PMID: 29698368 DOI: 10.1097/01.jaa.0000530293.13871.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article describes the use of vemurafenib, a BRAF inhibitor, to achieve disease regression in a woman with extensive metastatic melanoma and the BRAF V600 gene mutation. Given the improved survival rates seen in these patients, clinicians need to be aware of long-term patient management and adverse reactions to the drug.
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Affiliation(s)
- Breea Buckley
- At the time this article was written, Breea Buckley was a student in the PA program at Marietta (Ohio) College. Bradley Pierce is an assistant professor in the PA program at Marietta College and practices in the Strecker Cancer Center at Memorial Health System in Marietta, Ohio. The authors have disclosed no potential conflicts of interest, financial or otherwise
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7
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Peuvrel L, Quéreux G, Saint-Jean M, Brocard A, Nguyen JM, Khammari A, Knol AC, Varey E, Dréno B. Profile of vemurafenib-induced severe skin toxicities. J Eur Acad Dermatol Venereol 2015; 30:250-7. [PMID: 26524690 DOI: 10.1111/jdv.13443] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/04/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Vemurafenib, a BRAF inhibitor, is commonly associated with skin toxicity. The impact of severe forms is unknown. OBJECTIVE To determine the rate of permanent vemurafenib discontinuation due to grade 3-4 skin toxicity, features of these toxicities, their recurrence rate after a switch to dabrafenib and their impact on overall survival. METHODS Retrospective cohort study of 131 patients treated with vemurafenib for melanoma between November 2010 and December 2014. Data on skin toxicities, the need for vemurafenib adjustment and the impact of switching to dabrafenib were collected. Regarding survival analysis, a conditional landmark analysis was performed to correct lead-time bias. RESULTS Among the 131 vemurafenib-treated patients, 26% developed grade 3-4 skin toxicity. Forty-four percent of them permanently discontinued their treatment, mainly due to rash and classic skin adverse reactions (Steven-Johnson syndrome, Drug Reaction with Eosinophilia and Systemic Symptoms). Conversely, photosensitivity and carcinomas rarely required treatment adjustment. Grade 3-4 rashes were associated with clinical or biological abnormalities in 94% of patients. Among the 10 patients who subsequently switched to dabrafenib, skin toxicity recurred only in one patient. Overall survival was significantly prolonged in case of severe skin toxicity emerging within the first 4 (P = 0.014) and 8 weeks (P = 0.038) on vemurafenib, with only a trend at 12 weeks (P = 0.052). Median overall survival was also prolonged in case of severe rash. CONCLUSION In this study, vemurafenib was continued in 56% of patients with grade 3-4 skin toxicity, which was associated with prolonged overall survival when emerging within the first 4 and 8 weeks of treatment. While developing severe skin adverse reactions permanently contraindicates vemurafenib use, other rashes should lead to retreatment attempts with dose reduction. In case of recurrence, dabrafenib seems to be an interesting option. For other skin toxicities, including photosensitivity and cutaneous carcinoma, treatment adjustment is usually not needed.
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Affiliation(s)
- L Peuvrel
- Department of Dermatology, Nantes University Hospital, INSERM U892-CNRS U6299, CIC Biothérapie INSERM 0503, Nantes, France
| | - G Quéreux
- Department of Dermatology, Nantes University Hospital, INSERM U892-CNRS U6299, CIC Biothérapie INSERM 0503, Nantes, France
| | - M Saint-Jean
- Department of Dermatology, Nantes University Hospital, INSERM U892-CNRS U6299, CIC Biothérapie INSERM 0503, Nantes, France
| | - A Brocard
- Department of Dermatology, Nantes University Hospital, INSERM U892-CNRS U6299, CIC Biothérapie INSERM 0503, Nantes, France
| | - J M Nguyen
- Department of Epidemiology and Biostatistics, Nantes University Hospital, INSERM U892-CNRS U6299, CIC Biothérapie INSERM 0503, Nantes, France
| | - A Khammari
- Department of Dermatology, Nantes University Hospital, INSERM U892-CNRS U6299, CIC Biothérapie INSERM 0503, Nantes, France
| | - A C Knol
- Department of Dermatology, Nantes University Hospital, INSERM U892-CNRS U6299, CIC Biothérapie INSERM 0503, Nantes, France
| | - E Varey
- Department of Dermatology, Nantes University Hospital, INSERM U892-CNRS U6299, CIC Biothérapie INSERM 0503, Nantes, France
| | - B Dréno
- Department of Dermatology, Nantes University Hospital, INSERM U892-CNRS U6299, CIC Biothérapie INSERM 0503, Nantes, France
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