Sorafenib induces delayed-onset cutaneous hypersensitivity: a case series
Kyoung Hee Sohn1, Soo Yeon Oh2, Kyung Whan Lim1
1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.
Abstract:
Sorafenib is an oral multikinase inhibitor with clinical activity against hepatocellular carcinoma (HCC) and renal cell carcinoma. Administration of sorafenib carries a variety of adverse cutaneous reactions. Common adverse effects induced by sorafenib include hand-foot skin reactions, facial erythema, splinter subungual hemorrhage, and alopecia. Although erythema multiforme (EM) related to sorafenib has been reported, delayed-type cutaneous hypersensitivity reactions are rare in patients treated with sorafenib and there has been no case of Stevens-Johnson syndrome (SJS) reported so far. We recently experienced 3 cases of delayed-type cutaneous hypersensitivity related to administration of sorafenib. The first case was a 47-year female had targetoid erythematous rashes on her arms 12 days after starting sorafenib for HCC. The rashes spread from the arms to the trunk rapidly except for the hands and feet, and erosive lesions developed in the oral mucosa and lips. She was diagnosed as SJS. The second case was an 81-year-old male had maculopapular eruptions with multiple targetoid lesions on the trunk, arms, and legs 10 days after starting sorafenib for his HCC. There was no evidence of mucosal involvement. He was diagnosed with EM. The last one was a 20-year-old female developed generalized maculopapular eruptions in the whole body 10 days after starting sorafenib for the treatment of HCC. All 3 patients completely recovered after discontinuation of sorafenib.
Insights
Sorafenib can cause rare but severe skin reactions, including Stevens-Johnson syndrome (SJS) and erythema multiforme (EM). Early discontinuation of sorafenib led to complete recovery in three patients experiencing these adverse cutaneous events.
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.
More Related Videos
06:38An Oncogenic Hepatocyte-Induced Orthotopic Mouse Model of Hepatocellular Cancer Arising in the Setting of Hepatic Inflammation and Fibrosis
Published on: September 12, 2019
09:11Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma
Published on: May 24, 2024