Successful use of dabrafenib after the occurrence of drug rash with eosinophilia and systemic symptoms (DRESS) induced by vemurafenib

Pinard, C.; Mignard, C.; Samain, A; Duval-Modeste, Anne-Bénédicte; Joly, P.

doi:10.1016/j.jdcr.2017.06.027

Cited by 10 publications

(14 citation statements)

References 8 publications

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“…Contrary to what was suggested in both articles by Pinard et al 1 and Tahsen et al, 2 this case implies that the hypersensitivity reaction can be class specific rather than drug specific. Even if few cases noting the successful use of dabrafenib after vemurafenib-induced SCAR have been reported,1, 2, 4 the reintroduction cannot be alleged as safe and should be considered with care. In practice we do not suggest the avoidance dabrafenib after vemurafenib SCARs, but we emphasize that this introduction should take place within a hospitalized setting.…”

contrasting

confidence: 81%

“…To the Editor: We read with interest the recent case report by Pinard et al 1 about the successful introduction of dabrafenib after DRESS (drug rash with eosinophilia and systemic symptoms) induced by vemurafenib and more recently the same successful experience of Tahseen et al 2 after vemurafenib-induced toxic epidermal necrolysis. However, from our own practice, we would caution that these experiences should not be extended to all patients.…”

mentioning

confidence: 96%

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Reintroduction of dabrafenib after previous vemurafenib-induced DRESS: Not always safe!

et al. 2019

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confidence: 81%

mentioning

confidence: 96%

Reintroduction of dabrafenib after previous vemurafenib-induced DRESS: Not always safe!

et al. 2019

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“…7 For those who do not respond to immune checkpoint blockade therapy, it is equivalent to a death sentence because of the extremely severe course of metastatic malignant melanoma after vemurafenib withdrawal. 21 The successful use of dabrafenib in case of vemurafenibinduced severe AEs have been reported. 7 22-24 For a safe switch to dabrafenib, complete remission of vemurafenibrelated toxicity symptoms is required.…”

Section: Case Presentationmentioning

confidence: 99%

Rapid recovery of postnivolumab vemurafenib-induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome after tocilizumab and infliximab administration

Maximova

Maestro

Zanon

et al. 2020

J Immunother Cancer

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BackgroundImmune checkpoint inhibitors such as nivolumab and targeted BRAF inhibitors have dramatically altered the treatment outcomes of metastatic melanoma over the past few years. Skin toxicity is the most common adverse event (AE) related to the commonly used BRAF inhibitor vemurafenib, affecting more than 90% of patients. Vemurafenib-related severe AEs with early onset are reported in patients who were previously treated with anti-programmed cell death-1 (anti PD-1) antibodies. A prolonged administration of systemic steroids is the first-line treatment of severe or life-threatening AEs. We report the case of a woman suffering from vemurafenib-related severe, rapidly worsening Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome, resolved in a few hours after single-dose administration of a combination of TNF-α antagonist infliximab with interleukin (IL)-6 receptor antagonist tocilizumab.Case presentationA 41-year-old woman treated with single-agent nivolumab presented with a melanoma progression. Biopsy samples were revised, revealing a BRAF V600E mutation. The patient was started on vemurafenib and cobimetinib treatment only 10 days after the last administration of nivolumab. On the third day of anti-BRAF therapy, profound lymphopenia was detected, and maculopapular eruption appeared afterward. Subsequently, the clinical conditions deteriorated further, and the woman was admitted on an emergency basis with high fever, respiratory and cardiocirculatory failure, diffuse rash, generalized edema, and lymphadenopathy. Diagnosis of DRESS syndrome with overexpressed capillary leakage was made. A single dose of tocilizumab was administered with an improvement of cardiocirculatory and renal function in a few hours. Because of worsening of liver function, skin lesions and mucositis, a single dose of infliximab was prescribed, and dramatic improvement was noted over the next 24 hours. Dabrafenib and trametinib were initiated, and coinciding with washout of infliximab from the patient’s blood, the drug toxicity recurred.ConclusionAnti-IL-6 and anti-TNF-α target treatment of very severe AEs may afford an immediate resolution of potentially life-threatening symptoms and reduce the duration and the costs of hospitalization. Maintenance of therapeutic infliximab blood concentrations permits an early switch to dabrafenib after vemurafenib-related AEs.

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“…Dabrafenib was reported twice ( n = 2; 3%) as the causative drug of two DRESS cases (one after switching from a vemurafenib‐DRESS‐induced case) 20,21 . All the remainder ( n = 30; 98%) were caused by vemurafenib, which was related with melanoma in all of the cases 12–14,16,20–33 . A total of 64.5% ( n = 20) cases were related to the combination of vemurafenib and cobimetinib; 20,22,27–29 however, when an actual assessment of the culprit drug was performed (Naranjo scale, ALDEN score, patch test and/or in vitro analysis of lymphocyte reactivity), vemurafenib was the solo cause of the SCAR 15,25,27 .…”

Section: Resultsmentioning

confidence: 99%

“…Sixteen cases (51.6%) were treated with systemic corticosteroids 12,16,20,21,24–26,28,29,32,33 . Dabrafenib was a common‐used therapy after vemurafenib‐induced SCAR ( n = 16; 51.7%), 15,20–22,24–27,29,31 and no other SCAR was subsequently reported except in one case 21 …”

Section: Resultsmentioning

confidence: 99%

Systematic review of BRAF/MEK inhibitors‐induced Severe Cutaneous Adverse Reactions (SCARs)

Torres‐Navarro

Unamuno‐Bustos

Botella‐Estrada

2020

Acad Dermatol Venereol

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Severe cutaneous adverse reactions (SCARs) [Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic syndrome (DRESS), acute generalized exanthematous pustulosis (AGEP), and generalized bullous fixed eruption (GBFE)] are severe drug reactions that often require hospitalization and could be fatal. BRAF and MEK inhibitors (BRAF/MEKi) are a standard of care in patients with BRAF‐mutated metastatic melanomas. These agents are administered until disease progression or unacceptable toxicity occurs. This review has focus on BRAF/MEKi‐induced SCARs. A systematic search of the following terms: ‘vemurafenib’, ‘cobimetinib’, ‘dabrafenib’, ‘trametinib’, ‘encorafenib’, ‘binimetinib’, ‘Acute Generalized Exanthematous Pustulosis’, ‘Stevens Johnson syndrome’, ‘Toxic Epidermal Necrolysis’, ‘Generalized Bullous Fixed Eruption’ ‘Drug Hypersensitivity Syndrome’, and ‘DRESS’ in simple combination (every drug with each disease) and all in combination, was performed on MEDLINE, EMBASE, Web of Knowledge and The Cochrane Library repositories, with no restriction on language, for original studies. One hundred sixty‐eight original articles were found, 26 (retrospective series, case reports and conference abstracts) were selected, and 21 were included in the qualitative synthesis. A total of 31 SCAR cases (23 DRESS and 8 SJS/TEN – 1 SJS and 7 TEN –) were identified. Vemurafenib was the culprit drug in all but one case, which was dabrafenib‐induced. Mean time to SCAR onset from drug intake was 15.5 and 11.4 days, for SJS/TEN and DRESS, respectively. For the DRESS cases, hepatic involvement occurred in 96% and renal alterations in 87% of patients. Overall, BRAF/MEKi‐induced SCARs are rare. Among them, vemurafenib is the drug that requires more close monitoring for SCARs. Prior immunotherapy can favour SCARs. Vemurafenib DRESS is likely to occur within the first fifteen days of treatment accompanied by hepatic and renal involvement. Following vemurafenib‐induced SCAR resolution, switching to dabrafenib seems to be a safe alternative for these patients’ treatment.

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Successful use of dabrafenib after the occurrence of drug rash with eosinophilia and systemic symptoms (DRESS) induced by vemurafenib

Cited by 10 publications

References 8 publications

Reintroduction of dabrafenib after previous vemurafenib-induced DRESS: Not always safe!

Reintroduction of dabrafenib after previous vemurafenib-induced DRESS: Not always safe!

Rapid recovery of postnivolumab vemurafenib-induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome after tocilizumab and infliximab administration

Systematic review of BRAF/MEK inhibitors‐induced Severe Cutaneous Adverse Reactions (SCARs)

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