Early-Onset Vemurafenib-Induced DRESS Syndrome

Abstract

Vemurafenib is a BRAF inhibitor indicated in metastatic or unresectable melanoma in patients with BRAF mutations. Vemurafenib is frequently toxic, but the toxicity is often not serious. The third case of vemurafenib-induced drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is reported herein. The case is unusual in that the onset was early, with symptoms emerging as of day 8 of treatment. Treatment of DRESS syndrome is not currently based on precise recommendations, but systemic corticosteroid therapy is effective in serious cases. Severe toxidermias under vemurafenib are exceptional; immediate discontinuation of treatment upon diagnosis is imperative. Switching from vemurafenib to dabrafenib then seems to constitute an interesting therapeutic alternative, since its efficacy is the same but with fewer cutaneous adverse reactions. This case highlights the importance of awareness of the risk of DRESS syndrome associated with vemurafenib and monitoring for warning signs from treatment initiation.

DRESS syndrome due to vemurafenib treatment: switching BRAF inhibitor to solve a big problem

“…The onset time of this entity usually takes place between 2 and 6 weeks after the drug is initiated, although there are reported cases of early-onset DRESS syndrome in relation to vemurafenib 9. Complete recovery of the rash usually takes place between 6 and 9 weeks after drug cessation, but in 20%–30% of patients rash progresses to exfoliating dermatitis.…”

“…This BRAF inhibitor has demonstrated a response rate of 50% in patients with advanced melanoma and shown a significant benefit both in progression-free survival and overall survival. The most frequent adverse effects of vemurafenib are cutaneous, including pruritus, photosensitivity, hyperkeratosis, squamous carcinomas, keratoacanthomas and maculopapular rash, which can affect from 36% to 68% of patients,9 although rarely serious.…”

Vemurafenib‐induced DRESS/DIHS resulting in spontaneous melanoma regression: an immunological reaction shedding new light on melanoma treatment?

“…Following DRESS/DIHS, unexpectedly, the patient's melanoma regressed significantly despite just 1 week of targeted therapy and was maintained for 4 months. There are two additional cases of vemurafenib‐induced DRESS/DIHS with subsequent melanoma spontaneous regression 1‐3 . In these three cases, the response of melanoma regression was unexpected.…”

Management of the Cutaneous Adverse Effects of Antimelanoma Therapy

“…There have been three reported cases of vemurafenib (BRAFi)-induced DRESS syndrome and one case of ipilimumab-associated DRESS [60]. All cases of vemurafenib-induced DRESS occurred soon therapy initiation, between 8 days to 4 weeks [61]. There have also been two cases resembling DRESS in patients administered with vemurafenib following anti-PD-1 therapy [62].…”