BRAF inhibition and the spectrum of granulomatous reactions

Sample CME manuscript submission: Response to the article by Pham et al entitled “Review BRAF inhibition and the spectrum of granulomatous reactions”

“…Systemic manifestations included lymph node enlargement (n ¼ 12, 66%) and pulmonary infiltrates (n ¼ 6, 33%). Five (28%) patients had systemic manifestations with no skin involvement, similar to the results reported by Pham et al 1 Pham et al 1 reported that 20% of patients with GRs required systemic corticosteroids; in our study, 7 (39%) patients with GRs required systemic corticosteroids, possibly a direct consequence of the higher rate of systemic manifestations of GRs. A favorable outcome was observed in 89% of our patients; however, 2 patients were refractory to systemic corticosteroids and required second-line therapy with methotrexate.…”

“…GRs occurred on average 11 months after treatment introduction. In our cohort of patients, GRs mostly involved the skin (n ¼ 13, 72%), as previously reported in the study by Pham et al 1 However, we observed manifestations exclusively on the skin in only 3 (17%) patients-lower than the 67% recently reported. 1 The most representative skin lesions included erythema nodosum, isomorphic skin reactions, granulomatous nodules, and macrocheilitis.…”

“…BRAF inhibitor was discontinued in 1 patient (5%) with GR involving the skin only (similar to 5% reported in the study by Pham et al 1 ).…”

“…To the Editor: We read with great interest the recently published literature review by Pham et al 1 regarding the spectrum of granulomatous reactions (GRs) associated with BRAF inhibitors. In agreement with the authors regarding the variability in GR diagnosis and relevant inconsistencies in reported cases, we would like to add the findings on 18 patients with GR related to BRAF inhibitors from the oncodermatologyspecialized group of The European Academy of Dermatology and Venerology task force ''Dermatology for Cancer Patients.…”

“…GRs that are induced by BRAF inhibitors are an uncommon adverse event. Pham et al 1 recently described the largest series of BRAF inhibitorerelated GRs based on data from the literature. In contrast to the findings of Pham et al, 1 the patients in our study were recruited through clinical consultation by a homogeneous group of European experts in oncodermatology and a higher rate of systemic involvement was found in our cohort, requiring management with systemic immunosuppressive therapies.…”