Sorafenib induces delayed-onset cutaneous hypersensitivity: a case series

Area of Science:

• Oncology
• Dermatology
• Pharmacology

Background:

• Sorafenib is a multikinase inhibitor used for hepatocellular carcinoma (HCC) and renal cell carcinoma.
• Adverse cutaneous reactions are common with sorafenib, including hand-foot skin reactions, erythema, and alopecia.
• While erythema multiforme (EM) has been linked to sorafenib, severe delayed-type hypersensitivity reactions like Stevens-Johnson syndrome (SJS) are rare and previously unreported.

Purpose of the Study:

• To report three cases of delayed-type cutaneous hypersensitivity reactions to sorafenib.
• To highlight the potential for sorafenib to induce severe skin reactions, including SJS and EM.
• To emphasize the importance of recognizing and managing these adverse events.

Main Methods:

• Case series reporting three patients treated with sorafenib for HCC.
• Clinical presentation, diagnosis, and treatment outcomes were documented.
• Diagnosis of SJS and EM were based on clinical and pathological findings.

Main Results:

• Three patients developed severe cutaneous reactions after initiating sorafenib for HCC.
• One patient was diagnosed with Stevens-Johnson syndrome (SJS), presenting with targetoid rashes and mucosal erosions.
• Two patients were diagnosed with erythema multiforme (EM), one with targetoid lesions and another with generalized maculopapular eruptions. All patients recovered after sorafenib discontinuation.

Conclusions:

• Sorafenib can induce severe delayed-type cutaneous hypersensitivity reactions, including SJS and EM.
• Prompt recognition and discontinuation of sorafenib are crucial for patient recovery.
• These cases expand the known spectrum of sorafenib-induced dermatologic adverse events.