Development of Photoonycholysis with Vandetanib Therapy

Abstract

Vandetanib therapy is a novel once-daily oral multitargeted tyrosine kinase inhibitor, which is currently used in advanced or metastatic medullary thyroid cancer. Skin toxicities are among the most prevalent adverse events reported with this targeted therapy (e.g. acne-like rash, hand-foot skin reaction, hair changes, and paronychia). In addition, photosensitivity reactions may affect more than one third of treated patients. We report here 2 patients developing photosensitivity reactions with vandetanib therapy, including photoonycholysis. Our patients presented a wide range of phototoxic reactions with exaggerated sunburn reactions solely located to photoexposed areas or hyperpigmentation with visible blue dots. More importantly, both patients concomitantly developed nail changes consistent with type 1 photoonycholysis, which had never been reported so far neither with vandetanib therapy nor with other anticancer-targeted therapies. In addition, histopathologic findings and reflectance confocal microscopy imaging performed in one patient suffering from photodistributed skin hyperpigmentation both strengthen the likelihood of a postinflammatory mechanism. Clinicians should be aware of these underestimated but very characteristic photoinduced adverse events, which can lead to treatment interruption and require very strict photoprotective measures in treated patients.

Vandetanib induced photoallergic dermatitis: A case report

“…A previous study reported that vandetanib resulted in dermatologic side effects in 37% of the patients, causing sunburn-like erythema in the sun-exposed areas in most of the patients [3]. On the other hand, it has also been reported that vandetanib may lead to a sense of burning, edema, and bulla formation within several days or weeks after the initiation of the therapy [1].…”

“…As the EGFRs are intensely expressed in the epidermis, the hair follicles and the sebaceous glands, these inhibitors mostly lead to dermatological side effects in 50%-100% of the cases [5]. Most common dermatological side effects induced by vandetanib include papulopustular eruption, hand-foot syndrome, hyperpigmentation, mucosal changes, dry skin, hair changes, paronychia, and pyogenic granuloma [1,2,5].…”

“…Moreover, these chemicals absorb UV radiation, which is a photosensitizer [2]. Vandetanib also has a low molecular weight [1,2].…”

“…Vandetanib is a multi-kinase inhibitor of epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGFR) [1,2]. Vandetanib has been approved by the Food and Drug Administration for the treatment of advanced or metastatic thyroid medullar carcinoma.…”

“…Vandetanib has been approved by the Food and Drug Administration for the treatment of advanced or metastatic thyroid medullar carcinoma. In the literature, there are few cases of photoonycholysis, lichenoid photodermatitis and photoallergic dermatitis due to vandetanib treatment [1][2][3].…”