Skin toxicity of targeted therapy: Vemurafenib, first experiences from Montenegro

Abstract

Introduction: Data on melanoma incidence and mortality in Montenegro is only partially complete. GLOBOCAN and EUCAN reports estimate melanoma incidence in Montenegro to be between 4.6-7.3 cases/100 000.At least 50% of all metastatic melanoma cell lines carry an activating mutation in the BRAF oncogene. The treatment of advanced melanoma with the selective BRAF inhibitors, such as vemurafenib demonstrated improvement in progression free interval and overall survival when compared to conventional chemotherapy treatment. Up to 95% of patients treated with vemurafenib experience skin toxicity. Material and methods:Five patients with metastatic melanoma have been treated with vemurafenib at the Clinic for Oncology and Radiotherapy Podgorica, Montenegro, during the period 2013-2014. They were treated with standard dose (960 mg twice a day, per os). Data about the occurrence and management of skin side-effects in these patients were retrospectively collected from medical charts. Severity of side-effects was graded using the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 4.0.Results: In 2013, 41 new cases of melanoma were registered in Montenegro, 20 (48.7%) male and 21 (51.3%) female. In 2014, 49 new cases of melanoma were registered, 27 (55.1%) male and 22 (44.9%) female. Two out of five (40%) vemurafenib treated patients experienced photosensitivity, three (60%) had rash eruptions, four (80%) developed alopecia, and two (40%) had dry skin problems. Alteration in nevus color and size occurred in one (20%) patient, and two (40%) patients developed new pigmented lesions.Conclusion: Skin side effects associated with vemurafenib are plentiful, but generally manageable with supportive care measures. In our experience, majority of described side-effects were of grade 1 or 2, and none required dose modifications, or discontinuation of the therapy. Our experience suggests that patients taking BRAF inhibitors should have regular full body skin assessments, both prior to the beginning of the therapy and periodically after its onset. Clinicians should be aware of the skin related toxicities, in order to minimize their impact on treatment efficacy and patients' quality of life.