Clinico-morphological features of BRAF inhibition–induced proliferative skin lesions in cancer patients

Author： Belum Viswanath Reddy Rosen Alyx C. Jaimes Natalia Dranitsaris George Pulitzer Melissa P. Busam Klaus J. Marghoob Ashfaq A. Carvajal Richard D. Chapman Paul B. Lacouture Mario E.

Publisher： Blackwell Publishing

E-ISSN： 1097-0142|121|1|60-68

ISSN： 0008-543X

Source： Cancer, Vol.121, Iss.1, 2015-01, pp. : 60-68

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Abstract

The use of BRAF inhibitors may lead to the development of cutaneous toxicities such as rashes, photosensitivity, alopecia, palmoplantar erythrodysesthesia, and proliferative skin lesions, including keratoacanthomas (KAs) and cutaneous squamous cell carcinomas (cuSCCs). The latter are noteworthy for their potential to exhibit malignant features, and they may necessitate invasive treatment. Their prompt identification is of primary importance for directing supportive care efforts and maintaining dose intensity while minimizing the morbidity associated with supportive care interventions. Because such lesions are less familiar to oncologists, this study was designed to characterize their clinico-morphological features, which have not been hitherto described. Despite improved cancer outcomes with BRAF inhibitors, the characterization and management of the associated adverse events exemplify the challenges of survivorship care. Published studies involving BRAF inhibitors reflect an adverse event profile that is characterized by proliferative skin lesions (keratoacanthomas/cutaneous squamous cell carcinomas and verrucous lesions), maculopapular rashes, and hyperkeratosis. With regulatory approval and expanding use of vemurafenib and dabrafenib, oncologists will encounter proliferative skin lesions more often. Recognition of their key identifying features and appropriate management are crucial for ensuring consistent dosing of life-saving anticancer therapy, maintenance of health-related quality of life, and lower morbidity associated with adverse event management.