Continuing medical education
Cutaneous reactions to chemotherapeutic drugs and targeted therapy for cancer: Part II. Targeted therapy

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Targeted drugs are increasingly being used for cancer management. They are designed to block specific cancer cell processes, and are often better tolerated than conventional chemotherapeutic drugs. Cutaneous reactions, however, are not uncommon, because some target molecules are also present in the skin. Tyrosine kinase inhibitors can cause edema and macular rash, whereas papulopustular rash, paronychia, regulatory changes in hair, itching, and dryness caused by epidermal growth factor receptor inhibitors (PRIDE) syndrome can be seen in patients treated with these drugs. Vismodegib may result in muscle spasms and alopecia. Multiple rashes can be seen with bortezomib, while sunitinib and sorafenib cause hand–foot skin reactions. New melanoma therapies, such as ipilimumab, cause immune-related adverse events of dermatitis and pruritus, while BRAF inhibitors can produce exanthematous rash and lead to an increased risk of squamous cell carcinoma. Dermatologists should be aware of these new therapies and their cutaneous reactions to be able to provide appropriate care and management for cancer patients.

Section snippets

Signal transduction inhibitors

Key points

  1. Tyrosine kinase inhibitors for chronic myeloid leukemia may cause edema, hypopigmentation, and a generalized skin rash

  2. Epidermal growth factor receptor inhibitors can cause papulopustular rash, paronychia, regulatory hair changes, itching, and dryness syndrome

  3. Vismodegib, which targets the hedgehog pathway in basal cell carcinoma, may produce muscle spasms, alopecia, and dysgeusia

Apoptosis-inducing inhibitors

Key point

  1. Bortezomib causes different forms of skin rash because of the enhanced release of proinflammatory cytokines

Angiogenesis-inducing inhibitors

Key points

  1. Inhibitors of angiogenesis primarily cause localized patches of hand–foot skin reactions, but face, hair, nail, and oral reactions may also occur

  2. Sunitinib may cause yellowing of the skin, while sorafenib may cause squamous cell carcinoma or actinic keratosis eruptions

Immunomodulators

Key point

  1. Ipilimumab can cause immune-related adverse events, such as dermatitis, pruritus, enterocolitis, and hepatitis

Gene therapy

Key points

  1. BRAF inhibitors may cause skin toxicities via the inhibition of the mitogen-activated protein kinase pathway in keratinocytes

  2. Preliminary studies combining MEK and BRAF inhibitors show a potential decrease in the incidence of skin toxicity and squamous cell carcinoma

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    Funding sources: None.

    Dr Roh was a consultant for World Care. Dr Reyes-Habito has no conflicts of interest to declare.

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