Vemurafenib-Induced Toxic Epidermal Necrolysis: An Emerging Adverse Event

  • Ana Filipe Monteiro Interna do Internato de Formação Específica de Dermatovenereologia, Hospital de Santarém EPE, Santarém, Portugal
  • Margarida Rato Interna do Internato de Formação Específica de Dermatovenereologia, Hospital de Santarém EPE, Santarém, Portugal
  • César Martins Assistente Hospitalar Graduado de Dermatovenereologia, Hospital de Santarém EPE, Santarém, Portugal
Keywords: Antineoplastic Agents/adverse effects, Melanoma/drug therapy, Stevens-Johnson Syndrome/etiology, Vemurafenib

Abstract

Vemurafenib, a selective inhibitor of the BRAF V600 mutation, is Food and Drug Administration and European Medicines Agency approved for the treatment of stage IV metastatic melanoma alone or in combination. Among the adverse effects, cutaneous toxicity is the most common. Most of these reactions such as maculopapular rash, photosensitivity and hyperkeratotic lesions are manageable, and the majority of patients are able to continue therapy. However, a few cases of life-threatening severe cutaneous adverse reactions have been reported and drug withdrawal is mandatory in these cases. Herein, we report a case of vemurafenib- -induced toxic epidermal necrolysis in a patient receiving therapy for metastatic melanoma. After several hospital complications, our patient survived to the drug-induced reaction and he is in remission for 2 years.

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Author Biography

Ana Filipe Monteiro, Interna do Internato de Formação Específica de Dermatovenereologia, Hospital de Santarém EPE, Santarém, Portugal

Mestrado Integrado em Medicina pela Faculdade de Medicina na Universidade de Coimbra

Medica Interna de Formação Específica de Dermatovenerologia no Hospital Distrital de Santarém

References

Chapman PB, Hauschild A, Robert C, Haanen JB, Ascierto

P, Larkin J, et al. Improved survival with vemurafenib in

melanoma with BRAF V600E mutation. N Engl J Med.

;364:2507–16. doi: 10.1056/NEJMoa1103782.

Gençler B, Gönül M. Cutaneous side effects of BRAF

inhibitors in advanced melanoma: Review of the literature.

Dermatol Res Pract. 2016;2016:1–6. doi:

1155/2016/5361569.

Peuvrel L, Quéreux G, Saint-Jean M, Brocard A, Nguyen

JM, Khammari A, et al. Profile of vemurafenib-induced

severe skin toxicities. J Eur Acad Dermatol Venereol.

;30:250–7. doi: 10.1111/jdv.13443.

Sinha R, Edmonds K, Newton-Bishop JA, Gore ME, Larkin

J, Fearfield L. Cutaneous adverse events associated with

vemurafenib in patients with metastatic melanoma: practical

advice on diagnosis, prevention and management of

the main treatment-related skin toxicities. Br J Dermatol.

;167:987–94. doi: 10.1111/bjd.12010.

McArthur GA, Chapman PB, Robert C, Larkin J, Haanen

JB, Dummer R, et al. Safety and efficacy of vemurafenib

in BRAFV600E and BRAFV600K mutation-positive melanoma

(BRIM-3): extended follow-up of a phase 3, randomised,

open-label study. Lancet Oncol. 2014;15:323–32.

doi: 10.1016/S1470-2045(14)70012-9.

Sinha R, Lecamwasam K, Purshouse K, Reed J, Middleton

MR, Fearfield L. Toxic epidermal necrolysis in a patient

receiving vemurafenib for treatment of metastatic malignant

melanoma. Br J Dermatol. 2014;170:997–9. doi:

1111/bjd.12796.

Jeudy G, Dalac-Rat S, Bonniaud B, Hervieu A, Petrella T,

Collet E, et al. Successful switch to dabrafenib after vemurafenib-

induced toxic epidermal necrolysis. Br J Dermatol.

;172:1454–5. doi: 10.1111/bjd.13522.

Wantz M, Spanoudi-Kitrimi I, Lasek A, Lebas D, Quinchon

J-FJ-F, Modiano P. Necrolyse epidermique toxique au vemurafenib.

Ann Dermatol Vénéréol. 2014;141:215–8.

doi: 10.1016/j.annder.2013.10.054.

Lapresta A, Dotor A, González-Herrada C. Toxic epidermal

necrolysis induced by vemurafenib. Actas Dermosifiliogr.

;106:682–3. doi: 10.1016/j.ad.2015.03.008.

Arenbergerova M, Mrazova I, Horazdovsky J, Sticova E,

Fialova A, Arenberger P. Toxic epidermal necrolysis induced

by vemurafenib after nivolumab failure. J Eur Acad

Dermatology Venereol. 2017;31:e253–4. doi: 10.1111/

jdv.14010.

Kılıç S, Özkaya E, Baykal C, Vatansever S. Vemurafenib-

-induced toxic epidermal necrolysis: Is it an emerging side-

effect of the drug? J Eur Acad Dermatology Venereol.

;31:e354–5. doi: 10.1111/jdv.14150.

Ling-He Meng JZ, Meng LH, Zhang LT, Yu GX. Cytokines

induced skin adverse reactions. J Clin Exp Dermatol Res.

;5.

Guillot B, Blazquez L, Bessis D, Dereure O, Guilhou JJ.

A prospective study of cutaneous adverse events induced

by low-dose alpha-interferon treatment for malignant

melanoma. Dermatology. 2004;208:49–54. doi:

1159/000075046.

Published
2018-10-05
How to Cite
Monteiro, A. F., Rato, M., & Martins, C. (2018). Vemurafenib-Induced Toxic Epidermal Necrolysis: An Emerging Adverse Event. Journal of the Portuguese Society of Dermatology and Venereology, 76(3), 329-332. https://doi.org/10.29021/spdv.76.3.926
Section
Case Reports