Clinical and histopathologic characteristics of rash in cancer patients treated with mammalian target of rapamycin inhibitors Journal Article

Authors: Balagula, Y.; Rosen, A.; Tan, B. H.; Busam, K. J.; Pulitzer, M. P.; Motzer, R. J.; Feldman, D. R.; Konner, J. A.; Reidy-Lagunes, D.; Myskowski, P. L.; Lacouture, M. E.
Article Title: Clinical and histopathologic characteristics of rash in cancer patients treated with mammalian target of rapamycin inhibitors
Abstract: BACKGROUND: Dermatologic adverse events stemming from anticancer therapies have become an increasingly frequent clinical problem. Inhibitors of mammalian target of rapamycin (mTOR), such as temsirolimus and everolimus, have been associated with a high rate of skin eruptions, but their clinical and histopathologic characteristics have not been explored. METHODS: A retrospective analysis of patients who were referred to the Dermatology Service for diagnosis and management of rash in the setting of therapy with the mTOR inhibitors everolimus and temsirolimus was performed. The parameters that were studied included the time to onset, clinical presentation at the time of dermatologic evaluation, associated symptoms, evolution, results of microbiologic studies, concomitant medications, the need for dose reduction and/or treatment interruption because of rash, and routine histopathology. RESULTS: In total, 13 patients were analyzed. Most rashes were mild (grade 1; 31%) and moderate (grade 2; 54%) in severity, and grade 3 rashes were observed only in 2 patients (15%). The trunk was the most frequently affected region (77%), with the scalp (23%), face (38%), neck (54%), and extremities (69%) also commonly involved. Erythematous papules and pustules constituted the predominant primary lesion morphology (62%). No unique or uniform histopathologic reaction pattern was observed. The most common reaction pattern was that of a mixed, spongiotic interface and perivascular dermatitis, which was observed in 7 of 11 patients (63%). CONCLUSIONS: Although mTOR inhibitors may commonly induce erythematous papules and pustules, they are associated with a spectrum of lesion morphologies and a variety of histopathologic findings. Further clinicohistologic correlation studies are needed. Copyright © 2012 American Cancer Society.
Keywords: adult; clinical article; human tissue; aged; middle aged; prednisone; clinical feature; histopathology; bevacizumab; cancer combination chemotherapy; drug dose reduction; drug safety; treatment duration; antineoplastic agents; outcome assessment; disease association; drug eruption; skin biopsy; drug potency; drug effect; retrospective study; kidney carcinoma; temsirolimus; pruritus; rash; disease severity; mammalian target of rapamycin; clinical evaluation; erythema; methylprednisolone; papule; mammalian target of rapamycin inhibitor; doxycycline; cotrimoxazole; everolimus; sirolimus; bacterial superinfection; exanthema; diphenhydramine; clobetasol; uterus carcinoma; pustule; clindamycin; fluocinonide; adverse event; trunk; pancreatic neuroendocrine tumor; tor serine-threonine kinases; hydroxyzine; limb disease; doxepin; face rash; neck rash; scalp pruritus
Journal Title: Cancer
Volume: 118
Issue: 20
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2012-10-15
Start Page: 5078
End Page: 5083
Language: English
DOI: 10.1002/cncr.27505
PROVIDER: scopus
PUBMED: 22437824
Notes: --- - "Export Date: 2 November 2012" - "CODEN: CANCA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Mario E Lacouture
    276 Lacouture
  2. Robert Motzer
    769 Motzer
  3. Melissa P Pulitzer
    130 Pulitzer
  4. Jason Konner
    85 Konner
  5. Darren Richard Feldman
    172 Feldman
  6. Diane Lauren Reidy
    153 Reidy
  7. Belinda H Tan
    5 Tan
  8. Klaus J Busam
    540 Busam
  9. Patricia Myskowski
    137 Myskowski
  10. Alyx C Rosen
    16 Rosen