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Panniculitis in patients treated with BRAF inhibitors: a case series
Bonita Choy1, Shaun Chou, Rachael Anforth
1*Department of Dermatology, Westmead Hospital, Sydney, Australia; †Sydney Medical School, The University of Sydney, Sydney, Australia; and ‡Department of Tissue Pathology and Diagnostic Oncology, Pathology West, Institute of Clinical Pathology and Medical Research, Westmead, Sydney, Australia.
Abstract:
Panniculitis is a rare complication of BRAF inhibitor therapy that is used to treat patients with BRAF-mutated metastatic melanoma. We present a clinicopathologic review of 9 patients who developed panniculitis while on BRAF inhibitor therapy. In 13% of patients on vemurafenib, 3% of patients on dabrafenib and 10% on combination of dabrafenib + trametinib, tender erythematous nodular lesions of panniculitis appeared on legs, arms and trunk. Histological evaluation of 8 biopsies from 7 patients showed predominantly neutrophilic infiltrate in 4, lymphocytic in 1, and mixed in 3. Lesions with neutrophilic infiltrate appeared in earlier stages of treatment than those with mixed or lymphocytic infiltrate. All biopsies showed lobular involvement and 5 also had a septal component. In addition, 1 biopsy had lichenoid inflammation in the epidermis and the other had evidence of vasculitis. Most patients responded to conservative medical management without the need to reduce or to stop BRAF inhibitor therapy. Panniculitis seems to be a rare class effect of BRAF inhibitors that is predominantly lobular and neutrophilic, although other patterns can be seen.
Insights
Panniculitis is a rare BRAF inhibitor side effect in metastatic melanoma patients. Most cases showed skin lesions that responded well to conservative treatment, allowing continued therapy.
Area of Science:
- Dermatology
- Oncology
- Pharmacology
Background:
- BRAF inhibitors are crucial for treating BRAF-mutated metastatic melanoma.
- Panniculitis is a rare but recognized complication of BRAF inhibitor therapy.
- Understanding the clinicopathologic features and management of this adverse event is important.
Purpose of the Study:
- To review the clinicopathologic features of panniculitis in patients treated with BRAF inhibitors.
- To determine the incidence and presentation of panniculitis with different BRAF inhibitors.
- To evaluate the response to treatment and the impact on ongoing BRAF inhibitor therapy.
Main Methods:
- Clinicopathologic review of 9 patients with BRAF inhibitor-associated panniculitis.
- Analysis of patient data including drug, dosage, and treatment duration.
- Histopathological evaluation of skin biopsies to characterize inflammatory patterns.
- Assessment of treatment response to conservative management.
Main Results:
- Panniculitis occurred in 13% (vemurafenib), 3% (dabrafenib), and 10% (dabrafenib + trametinib) of patients.
- Lesions were tender, erythematous nodules on limbs and trunk.
- Histology predominantly showed lobular panniculitis, often with neutrophilic infiltrate, especially in early stages.
- Other findings included septal involvement, lichenoid inflammation, and vasculitis.
- Most patients responded to conservative management without dose modification or discontinuation of BRAF inhibitors.
Conclusions:
- Panniculitis is a rare class effect of BRAF inhibitors in metastatic melanoma.
- The presentation is typically a lobular, neutrophilic panniculitis, but variations exist.
- Conservative management is often effective, allowing continuation of vital BRAF inhibitor therapy.
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