Sorafenib-induced premalignant and malignant skin lesions
Victoria L Williams1, Philip R Cohen, David J Stewart
1Baylor College of Medicine, Houston, TX, USA.
Purpose:
To review characteristics of patients who develop premalignant and malignant skin lesions while on sorafenib therapy and discuss implications for subsequent treatment of their primary malignancies.
Background:
Sorafenib is a newly developed multitargeted protein kinase inhibitor reported to induce a variety of adverse cutaneous effects, rarely including actinic keratoses, keratocanthomas, and squamous cell carcinomas (SCCs).
Methods:
Published reports of individuals who have developed cutaneous lesions demonstrating atypia of the epidermis are reviewed. In addition, a 77-year-old man who developed not only an SCC but also verrucas within one month of taking sorafenib monotherapy for metastatic adenocarcinoma of the lung is described.
Results:
Cutaneous lesions develop most commonly in Caucasian men older than 40 years without previous histories of skin cancer, within two weeks to three years of starting sorafenib therapy. Currently there is no definitive explanation for the relationship between sorafenib and cutaneous neoplasms. Management typically involves treatment of skin lesions with cryotherapy or excision with at least a brief discontinuation of sorafenib. In patients whose primary malignancies were responding well, sorafenib therapy was continued with close follow-up.
Conclusions:
The possibility of rapidly developing actinic keratoses, keratocanthomas, verrucas, and SCC during treatment with sorafenib, warrants close dermatologic follow-up and a lower threshold for biopsy and treatment of suspicious cutaneous lesions. Development of a sorafenib-induced SCC is not an absolute contraindication for continued use of sorafenib therapy; however, the drug should be briefly discontinued until lesions are treated.
Insights
Sorafenib therapy can cause skin lesions like squamous cell carcinomas (SCCs). Close dermatologic monitoring and prompt treatment are recommended, but sorafenib can often be continued.
Area of Science:
- Oncology
- Dermatology
- Pharmacology
Background:
- Sorafenib, a kinase inhibitor, is known to cause adverse skin reactions.
- Rarely, these reactions include premalignant and malignant skin lesions such as actinic keratoses, keratocanthomas, and squamous cell carcinomas (SCCs).
Purpose of the Study:
- To characterize patients developing skin lesions during sorafenib treatment.
- To discuss management and implications for ongoing cancer therapy.
Main Methods:
- Review of published cases of sorafenib-induced cutaneous lesions.
- Case report of a patient with SCC and verrucas during sorafenib therapy.
Main Results:
- Lesions typically affect Caucasian men over 40, appearing 2 weeks to 3 years after starting sorafenib.
- No clear mechanism links sorafenib to these skin neoplasms.
- Management includes lesion treatment and possible temporary sorafenib discontinuation.
Conclusions:
- Rapid development of lesions like SCCs during sorafenib therapy necessitates vigilant dermatologic surveillance.
- Biopsy and treatment of suspicious lesions should be considered promptly.
- Sorafenib-induced SCCs do not preclude continued sorafenib use if the primary cancer responds, provided the lesions are treated and the drug is temporarily paused.
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