Case Report/Case Series |

Vemurafenib and Radiosensitization

Lise Boussemart, MD1; Catherine Boivin, MD2; Joël Claveau, MD2; Yun Gan Tao, MD3; Gorana Tomasic, MD4; Emilie Routier, MD1; Christine Mateus, MD1; Eric Deutsch, MD, PhD3; Caroline Robert, MD, PhD1
[+] Author Affiliations
1Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
2Department of Dermatology, Melanoma and Skin Cancer Clinic, Centre hospitalier universitaire de Québec—Hôpital Hôtel-Dieu, Quebec City, Quebec, Canada
3Department of Radiation Oncology (Drs Tao and Deutsch), Institut Gustave Roussy, Villejuif, France
4Department of Pathology, Institut Gustave Roussy, Villejuif, France
JAMA Dermatol. 2013;149(7):855-857. doi:10.1001/jamadermatol.2013.4200.
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Importance  The BRAF inhibitor, vemurafenib, was recently approved for the treatment of patients with BRAFV600 metastatic melanoma. Wider use of this drug and longer follow-up periods of treatment are resulting in the emergence of a growing number of reports detailing new adverse effects. Cutaneous adverse effects are preeminent with UV-A–dependent phototoxicity, hyperkeratotic folliculitis, hand-foot skin reaction, hair changes, verrucous papillomas, keratoacanthomas, and squamous cell carcinomas.

Observations  We report 2 cases of dermatitis occurring on a previously irradiated skin area in patients treated with vemurafenib for a BRAFV600-mutated metastatic melanoma. The first case occurred 10 days after a low dose of radiation was delivered that usually does not induce any radiodermatitis, suggesting radiosensitization by vemurafenib. The second case occurred 30 days after radiotherapy and was diagnosed as radiation recall dermatitis.

Conclusions and Relevance  Vemurafenib should be considered a potential cutaneous radiosensitizer and an inducer of radiation recall dermatitis. However, these adverse effects are easily managed with topical corticosteroids. Dose reduction or interruption of vemurafenib is not required. Further studies and reports will enlighten us as to whether this pharmacodynamic interaction between x-rays and vemurafenib is also seen with other BRAF or MEK inhibitors on the same mitogen-activated protein kinase pathway currently under development.

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Figure 1.
Vesicular Erythematous Dermatitis

Vesicular erythematous dermatitis strictly located around the right shoulder skin metastasis in patient 1.

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Figure 2.
Skin Biopsy Specimen

Skin biopsy specimen from the dermatitis observed around the previously irradiated skin metastasis in patient 1 (hematoxylin and eosin, ×5 [A] and ×10 [B]).

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Figure 3.
Sharply Delimited Rectangular Eczematous Plaque

Sharply delimited rectangular eczematous plaque on the buttock in patient 2, exactly matching the previously irradiated field.

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Vemurafenib and radiosensitization. JAMA Dermatol 2013;149(7):855-7.
[Radiosensitization induced by vemurafenib]. Cancer Radiother 2013 Jul-Aug;17(4):304-7.