Vemurafenib-induced toxic epidermal necrolysis: possible cross-reactivity with other sulfonamide compounds

被引:23
作者
Bellon, T. [1 ]
Lerma, V. [2 ]
Gonzalez-Valle, O. [3 ]
Gonzalez Herrada, C. [3 ]
de Abajo, F. J. [2 ,4 ]
机构
[1] Univ Hosp La Paz IdiPAZ, Inst Hlth Res, P Castellana 261, Madrid 28046, Spain
[2] Principe Asturias Univ Hosp, Clin Pharmacol Unit, Madrid, Spain
[3] Univ Hosp Getafe, Dept Dermatol, Madrid, Spain
[4] Univ Alcala, Dept Biomed Sci Pharmacol, Madrid, Spain
关键词
STEVENS-JOHNSON-SYNDROME; HYPERSENSITIVITY REACTIONS; DIAGNOSIS; MELANOMA; BRAF;
D O I
10.1111/bjd.14201
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Vemurafenib is a newly licensed target-directed medication. It has been proven to improve the survival of patients with metastatic melanoma and the BRAFV600E mutation; however, adverse cutaneous reactions are frequent. Few cases of life-threatening severe cutaneous adverse reactions (SCARs) induced by vemurafenib have been reported. Dabrafenib, another selective BRAF inhibitor, has been licensed recently as an alternative drug with the same indications. From a molecular point of view, both vemurafenib and dabrafenib contain a sulfonamide group; cross-reactivity to sulfonamide compounds has been reported in allergic patients. We report on a patient with vemurafenib-induced toxic epidermal necrolysis (TEN). In vitro analysis of lymphocyte reactivity to vemurafenib showed positive results, confirming drug causality. In addition, lymphocytes from the patient reacted to dabrafenib and to the antibiotic sulfonamide drug sulfamethoxazole. Moreover, lymphocytes from two patients with cutaneous adverse reactions to sulfamethoxazole also reacted to vemurafenib and dabrafenib in vitro. These data strongly suggest that there might be clinical cross-reactivity between BRAF inhibitors and sulfonamides in some patients. Thus, precautions should be taken to avoid sulfonamide drugs as much as possible in patients showing serious hypersensitivity reactions to vemurafenib and vice versa.
引用
收藏
页码:621 / 624
页数:4
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