Skin rash secondary to bevacizumab in a patient with advanced colorectal cancer and relation to response

Abstract

Bevacizumab (Avastin) in combination with intravenous 5-fluorouracil-based chemotherapy as first-line as well as second-line treatment of metastatic colorectal cancer improves survival. Although skin rash (type unspecified) has been described in some patients following infusion of bevacizumab, it is not a common toxicity of bevacizumab, while acneiform rash occurs in more than 90% of patients who receive cetuximab (Erbitux), the severity of which appears to be predictive of response. We report a patient with colorectal cancer who developed a rash secondary to bevacizumab that correlated with response. A 40-year-old patient with stage IV colorectal cancer received FOLFOX-4 and bevacizumab, which he tolerated very well except for a skin rash related to bevacizumab. The rash cleared every time bevacizumab was eliminated from the chemotherapy regimen. When use of bevacizumab was resumed, similar rash reappeared. Therefore, we believe that this observation of the rash emergence was linked to bevacizumab administration. The most common toxicities associated with bevacizumab include hypertension, hemorrhage, gastrointestinal perforation, arterial thromboembolism, wound healing and proteinuria. Exfoliative dermatitis and a nonspecific rash have been reported with bevacizumab. This case report, we believe, is the first report of a possible correlation between a rash and a positive drug response associated with bevacizumab, and may initiate further investigation of similar observation.

Therapeutic Protein Kinase Inhibitors

“…Other RTK inhibitors such as sunitinib and sorafenib also have the potential of cutaneous toxic side effects of dry skin and rash [143]. Although skin toxicity is not a very common side effect for anti-VEGF therapy, recently a correlation was also made between the development of rash during bevacizumab treatment and a positive response in patients with metastatic colorectal cancer [144,145].…”

Cutaneous adverse reactions to therapeutic monoclonal antibodies for cancer

“…Bevacizumab received FDA approval in February 2004 as first-line treatment for metastatic colorectal cancer; in June 2006, it was approved for second-line treatment, in combination with oxaliplatin and 5-fluorouracil, for patients with metastatic or advanced colorectal carcinoma, who had already been treated with irinotecan and 5-fluorouracil-containing regimens. In addition, in October 2006, the FDA approved bevacizumab, in combination with paclitaxel and carboplatin, as initial therapy of locally advanced, recurrent or metastatic non-squamous non-small cell lung cancer [18][19][20].…”

“…Bevacizumab (Avastin, Genetech, San Francisco, CA, USA) is a humanized IgG1 monoclonal antibody against vascular endothelial growth factor (VEGF), and is the first antiangiogenic agent to be approved for use in cancer [18][19][20]. Bevacizumab received FDA approval in February 2004 as first-line treatment for metastatic colorectal cancer; in June 2006, it was approved for second-line treatment, in combination with oxaliplatin and 5-fluorouracil, for patients with metastatic or advanced colorectal carcinoma, who had already been treated with irinotecan and 5-fluorouracil-containing regimens.…”

Toxicité cutanée induite par les thérapies ciblées anti-angiogéniques

“…Wasif Saif et al avancent une relation possible entre rash et ré ponse thé rapeutique à propos de deux observations [11,32]. L'intensité de ces rashs semble en revanche modé ré e. Un prurit peut ê tre pré sent, parfois nu, et estimé à 20 % des cas [22].…”