Severe radiation dermatitis associated with concomitant vemurafenib therapy in a patient with metastatic melanoma

Saco, Michael; Mitchell, Christina L.

doi:10.1016/j.jaad.2013.10.046

Cited by 7 publications

(7 citation statements)

References 4 publications

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“…All grade 3 dermatologic reactions have been described with concurrent RT and BRAFi administration (19, 22, 27, 29-32) or when starting BRAFi within 2 days of RT (16) except for 1 patient who received 71 Gy in 38 fractions to the neck nodal basin followed by vemurafenib 6 weeks later (36). This patient received the highest dose of all patients reviewed, and a grade 3 dermatitis requiring a 1-week break from RT occurred before vemurafenib was started 6 weeks later.…”

Section: Dermatologic Toxicitymentioning

confidence: 99%

“…Some recommend concurrent treatment only within a clinical trial (70), whereas others advise caution but believe concurrent treatment is safe, noting that dermatologic reactions respond well to corticosteroids (29, 32, 34, 37). However, the severity of grade 3 reactions should not be dismissed, and of greater concern are potentially fatal toxicities related to the combination.…”

Section: Recommendationsmentioning

confidence: 99%

See 1 more Smart Citation

Avoiding Severe Toxicity From Combined BRAF Inhibitor and Radiation Treatment: Consensus Guidelines from the Eastern Cooperative Oncology Group (ECOG)

Anker

Grossmann

Atkins

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

135

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BRAF kinase gene V600 point mutations drive approximately 40% to 50% of all melanomas, and BRAF inhibitors (BRAFi) have been found to significantly improve survival outcomes. Although radiation therapy (RT) provides effective symptom palliation, there is a lack of toxicity and efficacy data when RT is combined with BRAFi, including vemurafenib and dabrafenib. This literature review provides a detailed analysis of potential increased dermatologic, pulmonary, neurologic, hepatic, esophageal, and bowel toxicity from the combination of BRAFi and RT for melanoma patients described in 27 publications. Despite 7 publications noting potential intracranial neurotoxicity, the rates of radionecrosis and hemorrhage from whole brain RT (WBRT), stereotactic radiosurgery (SRS), or both do not appear increased with concurrent or sequential administration of BRAFis. Almost all grade 3 dermatitis reactions occurred when RT and BRAFi were administered concurrently. Painful, disfiguring nondermatitis cutaneous reactions have been described from concurrent or sequential RT and BRAFi administration, which improved with topical steroids and time. Visceral toxicity has been reported with RT and BRAFi, with deaths possibly related to bowel perforation and liver hemorrhage. Increased severity of radiation pneumonitis with BRAFi is rare, but more concerning was a potentially related fatal pulmonary hemorrhage. Conversely, encouraging reports have described patients with leptomeningeal spread and unresectable lymphadenopathy rendered disease free from combined RT and BRAFi. Based on our review, the authors recommend holding BRAFi and/or MEK inhibitors ≥3 days before and after fractionated RT and ≥1 day before and after SRS. No fatal reactions have been described with a dose <4 Gy per fraction, and time off systemic treatment should be minimized. Future prospective data will serve to refine these recommendations.

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Section: Dermatologic Toxicitymentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

Avoiding Severe Toxicity From Combined BRAF Inhibitor and Radiation Treatment: Consensus Guidelines from the Eastern Cooperative Oncology Group (ECOG)

Anker

Grossmann

Atkins

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

135

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“…5 This classification tool defines radiation dermatitis as a “cutaneous inflammatory reaction occurring as a result of exposure to biologically effective levels of ionizing radiation.” In the clinical literature, radiation dermatitis is used interchangeably with radiation-induced skin injury. 6 – 10 Consequently, the available outcomes-based research is extremely heterogeneous, making it very difficult to draw conclusions regarding consensus guidelines and standards of care. 11 …”

Section: Radiation Dermatitis or Radiation-induced Skin Injurymentioning

confidence: 99%

“…In the clinical literature, radiation dermatitis is used interchangeably with radiation-induced skin injury. [6][7][8][9][10] Consequently, the available outcomes-based research is extremely heterogeneous, making it very difficult to draw conclusions regarding consensus guidelines and standards of care. 11 In addition to the CTCAE scale, clinicians often use the Radiation Therapy Oncology Group (RTOG) grading criteria as a standardized tool in the assessment of radiation injury severity during the manifestation of illness.…”

Section: Radiation Dermatitis or Radiation-induced Skin Injurymentioning

confidence: 99%

Review of the Terminology Describing Ionizing Radiation-Induced Skin Injury: A Case for Standardization

Burnett

Hughes

Rejeski

et al. 2021

Technol Cancer Res Treat

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Ionizing radiation causes injury to the skin that produces a complex clinical presentation that is managed by various paradigms without clear standards. The situation is further complicated by the fact that clinicians and researchers often use different terms and billing codes to describe the spectrum of cutaneous injury. There is, however, general agreement between the two most commonly-used diagnostic scales, the Radiation Therapy Oncology Group and the Common Terminology Criteria for Adverse Events, and in their use to describe skin injury following radiation therapy. These scales are typically used by radiation oncologists to quantify radiation dermatitis, a component of the radiation-related disorders of the skin and subcutaneous tissue family of diagnoses. In rare cases, patients with severe injury may require treatment by wound care or burn specialists, in which case the disease is described as a “radiation burn” and coded as a burn or corrosion. Further compounding the issue, most US government agencies use the term Cutaneous Radiation Injury to indicate skin damage resulting from large, whole-body exposures. In contrast, the US Food and Drug Administration approves products for radiation dermatitis or “burns caused by radiation oncology procedures.” A review of the literature and comparison of clinical presentations shows that each of these terms represents a similar injury, and can be used interchangeably. Herein we provide a comparative review of the commonly used terminology for radiation-induced skin injury. Further, we recommend standardization across clinicians, providers, and researchers involved in the diagnosis, care, and investigation of radiation-induced skin injury. This will facilitate collaboration and broader inclusion criteria for grant-research and clinical trials and will assist in assessing therapeutic options particularly relevant to patient skin pigmentation response differences.

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“…This classification tool defines radiation dermatitis as a "cutaneous inflammatory reaction occurring as a result of exposure to biologically effective levels of ionizing radiation. " In the literature, radiation dermatitis is used interchangeably with radiationinduced skin injury [3][4][5][6][7].…”

Section: Radiation Dermatitis or Radiation-induced Skin Injurymentioning

confidence: 99%

https://researchopenworld.com/endoscopic-removal-of-eroded-gastric-bands-using-lithotripsy-devices-a-case-series/#

2019

Interv Med Clin Imaging

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Severe radiation dermatitis associated with concomitant vemurafenib therapy in a patient with metastatic melanoma

Cited by 7 publications

References 4 publications

Avoiding Severe Toxicity From Combined BRAF Inhibitor and Radiation Treatment: Consensus Guidelines from the Eastern Cooperative Oncology Group (ECOG)

Avoiding Severe Toxicity From Combined BRAF Inhibitor and Radiation Treatment: Consensus Guidelines from the Eastern Cooperative Oncology Group (ECOG)

Review of the Terminology Describing Ionizing Radiation-Induced Skin Injury: A Case for Standardization

https://researchopenworld.com/endoscopic-removal-of-eroded-gastric-bands-using-lithotripsy-devices-a-case-series/#

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