Severe cutaneous adverse reactions induced by targeted anticancer therapies and immunotherapies

被引：118

作者：

Chen, Chun-Bing ^{[1
,2
,3
,4
,5
,6
]}

Wu, Ming-Ying ^{[1
,2
,3
,4
]}

Ng, Chau Yee ^{[1
,2
,3
,4
,5
]}

Lu, Chun-Wei ^{[1
,2
,3
,4
,5
,6
]}

Wu, Jennifer ^{[1
,2
,3
,4
,6
]}

Kao, Pei-Han ^{[1
,2
,3
,4
,6
]}

Yang, Chan-Keng ^{[4
,5
,6
,7
]}

Peng, Meng-Ting ^{[4
,6
,7
]}

Huang, Chen-Yang ^{[4
,6
,7
]}

Chang, Wen-Cheng ^{[4
,6
,7
]}

Hui, Rosaline Chung-Yee ^{[1
,4
]}

Yang, Chih-Hsun ^{[1
,2
,3
,4
]}

Yang, Shun-Fa ^{[6
,8
,9
]}

Chung, Wen-Hung ^{[1
,2
,3
,4
,6
,10
,11
]}

Su, Shih-Chi ^{[1
,2
,3
,4
,10
]}

机构：

[1] Chang Gung Mem Hosp, Dept Dermatol, Drug Hypersensit Clin & Res Ctr, Linkou, Taiwan

[2] Chang Gung Mem Hosp, Dept Dermatol, Drug Hypersensit Clin & Res Ctr, Taipei, Taiwan

[3] Chang Gung Mem Hosp, Dept Dermatol, Drug Hypersensit Clin & Res Ctr, Keelung, Taiwan

[4] Chang Gung Univ, Coll Med, Taoyuan, Taiwan

[5] Chang Gung Univ, Grad Inst Clin Med Sci, Coll Med, Taoyuan, Taiwan

[6] Chang Gung Mem Hosp, Immune Oncol Ctr Excellence, Linkou, Taiwan

[7] Chang Gung Mem Hosp, Div Hematol Oncol, Dept Internal Med, Linkou, Taiwan

[8] Chung Shan Med Univ, Inst Med, 110 Chien Kuo North Rd,Sect 1, Taichung 402, Taiwan

[9] Chung Shan Med Univ Hosp, Dept Med Res, Taichung, Taiwan

[10] Chang Gung Mem Hosp, Whole Genome Res Core Lab Human Dis, 222 Maijin Rd, Keelung 204, Taiwan

[11] Xiamen Chang Gung Hosp, Dept Dermatol, Xiamen, Peoples R China

来源：

CANCER MANAGEMENT AND RESEARCH | 2018年 / 10卷

关键词：

acute generalized exanthematous pustulosis; drug rash; eosinophilia; Stevens-Johnson syndrome; toxic epidermal necrolysis; targeted therapy; immunotherapy; TOXIC EPIDERMAL NECROLYSIS; STEVENS-JOHNSON-SYNDROME; GENERALIZED EXANTHEMATOUS PUSTULOSIS; LYMPHOCYTE-TRANSFORMATION TEST; ANTI-CD20; MONOCLONAL-ANTIBODY; SYSTEMIC SYMPTOMS DRESS; METASTATIC MELANOMA; DRUG REACTION; SKIN REACTION; BORTEZOMIB TREATMENT;

D O I：

10.2147/CMAR.S163391

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

With the increasing use of targeted anticancer drugs and immunotherapies, there have been a substantial number of reports concerning life-threatening severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms, drug-induced hypersensitivity syndrome, and acute generalized exanthematous pustulosis. Although the potential risks and characteristics for targeted anticancer agent-and immunotherapy-induced SCAR were not well understood, these serious adverse reactions usually result in morbidity and sequela. As a treatment guideline for this devastating condition is still unavailable, prompt withdrawal of causative drugs is believed to be a priority of patient management. In this review, we outline distinct types of SCARs caused by targeted anticancer therapies and immunotherapies. Also, we discuss the clinical course, latency, concomitant medication, tolerability of rechallenge or alternatives, tumor response, and mortality associated with these devastating conditions. Imatinib, vemurafenib, and rituximab were the top three offending medications that most commonly caused SJS/TEN, while EGFR inhibitors were the group of drugs that most frequently induced SJS/TEN. For drug rash with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome and acute generalized exanthematous pustulosis, imatinib was also the most common offending drug. Additionally, we delineated 10 SCAR cases related to innovative immunotherapies, including PD1 and CTLA4 inhibitors. There was a wide range of latency periods: 5.5-91 days (median). Only eight of 16 reported patients with SCAR showed clinical responses. Targeted anticancer drugs and immunotherapies can lead to lethal SCAR (14 deceased patients were identified as suffering from SJS/TEN). The mortality rate of TEN was high: up to 52.4%. The information compiled herein will serve as a solid foundation to formulate ideas for early recognition of SCAR and to discontinue offending drugs for better management.

引用

页码：1259 / 1273

页数：15

共 145 条

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