Ara C face: Cytarabine related dermatological toxicity

This is Letter to the Editor

Dermatological toxicity of EGFR inhibitors: pathogenetic rationale and an algorithm for acne-like rash correction

Therapy with epidermal growth factor receptor (EGFR) inhibitors is inevitably accompanied by the phenomena of dermatological toxicity. Being, on the one hand, a favorable prognostic factor for the effectiveness of anticancer therapy, these adverse events are one of the most frequent indications for treatment withdrawal. This article presents the clinical characteristics of a wide spectrum of dermatological adverse events, as well as the pathogenetic rationale for their correction. Algorithms for prescribing of external and systemic therapy based on the assessment of severity of skin lesions and skin appendages involvement are presented.

Cutaneous adverse events associated with immune checkpoint blockade: A meta-analysis.

e14500 Background: Dermatological toxicity is the most common immune-related adverse events (irAEs) following immune checkpoint inhibitors (ICIs). A better understanding of this side effect enables early recognition, diagnosis, and management in clinical practice. Methods: We did a meta-analysis of literature published on ClinialTrials.gov, Pubmed, Embase, and Cochrane Library up to April 30, 2020. Randomized controlled trials (RCTs) which reported the cases of cutaneous irAEs following ICIs (anti-PD-1, anti-PD-L1, anti-CTLA-4) were included. We comprehensively assessed the differences in cutaneous irAEs among ICIs, the effect from dosage and combined treatment on the incidence, the correlations of cutaneous irAE with other organ-specific irAEs, and the predictive values for prognosis. This study was prospectively registered in the PROSPERO platform (ID: CRD42020182247). Results: A total of 687 publications were initially identified and 46 eligible RCTs involving 28569 patients were included. Compared with that in patients receiving anti-CLTA-4 antibody, the overall risk of dermatological irAEs tended to be lower in patients receiving anti-PD-1 antibody (RRrash, 0.60; 95%CrI, 0.36-0.99; RRpruritus, 0.51; 95%CrI, 0.22-1.10) and was lower in those receiving anti-PD-L1 antibody (RRrash, 0.63; 95%CrI, 0.43-0.90; RRpruritus, 0.37; 95%CrI, 0.20-0.67). In general, neither treatment in combination nor dosage were estimated to add additional risk to the incidence of cutaneous irAEs. Dermatological toxicity was positively associated with immune-related hepatitis (P = 0.006), neuropathy (P = 0.040) and gastrointestinal dysfunctions (P = 0.038). The cutaneous irAEs was not confirmed as a surrogate predictor for survival with ICIs monotherapy. Conclusions: This study indicates that cutaneous irAEs are dose-independent and agent-specific immune reactions with the highest risk observed in CTLA-4 blockade, and the occurrence is associated with hepatic, neurological, and gastrointestinal disorders. The exploration in the predictive value of cutaneous irAEs for response and survival outcomes will be warranted in the future.

Refractory dermatitis contributed by pityriasis versicolor: a case report

Background Dermatologic toxicity is a very common immune-related adverse event (irAE) for patients with melanoma who are receiving immune checkpoint inhibitor therapy (ICI). Concurrent skin infection, such as in the case of pityriasis versicolor reported here, can mimic and/or exacerbate dermatologic toxicity from irAE. Case presentation A 58-year-old Caucasian man with a history of pityriasis versicolor infection and metastatic melanoma received ICI therapy. He developed progressively worsening pruritic maculopapular lesions 22 weeks into his treatment that ultimately covered 40% of his body. He was diagnosed with dermatologic toxicity due to ICI therapy with concurrent pityriasis versicolor. He was initially started on topical steroid and topical antifungal cream but achieved minimum improvement. His treatment was then escalated to oral prednisone, but it only achieved modest control of his dermatitis. All subsequent attempts to wean him from oral prednisone resulted in worsening of his dermatitis. Eventually he was started on oral fluconazole in combination with prednisone, which led to rapid resolution of his dermatitis. Conclusion We report a case of dermatological toxicity due to an irAE with concurrent pityriasis versicolor. The steroid treatment for irAE was likely exacerbating the underlying fungal infection, and the fungal infection was in term mimicking the symptoms of irAE. This patient’s severe dermatitis was only brought under control after receiving a more potent antifungal therapy in combination with a steroid. It is vital to look beyond the irAE when managing dermatitis in patients receiving ICI therapy.

Adverse reactions during chemotherapy: skin toxicity

Chemotherapy of oncological diseases is associated with high toxicity. The occurrence of various toxic reactions during the use of antitumor drugs is explained by the fact that most antitumor medicines are not strictly specific, therefore, their effect can extend not only to tumor cells, but also to normal cells, especially to tissues with rapid proliferation. All antitumour agents have skin toxicity in one form or another. However, for some chemotherapeutic agents, skin toxicity is a kind of «reflection» of certain mechanisms of drugs action, and, in most cases, the severity of dermatological reactions correlates with the effectiveness of chemotherapy. Dermatological toxicity deserves special attention, as it affects the quality of life of cancer patients and, in some cases, may require a dose reduction or even cancellation of chemotherapy. This article presents current data on the mechanisms of development of skin toxicity of routine chemotherapeutic agents, growth factor inhibitors and some antitumor antibiotics, its correction and prevention opportunities.