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Development of Photoonycholysis with Vandetanib Therapy
Miruna Negulescu1, Slimane Zerdoud2, Serge Boulinguez1
1Department of Oncodermatology, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, France.
Abstract:
Vandetanib therapy is a novel once-daily oral multitargeted tyrosine kinase inhibitor, which is currently used in advanced or metastatic medullary thyroid cancer. Skin toxicities are among the most prevalent adverse events reported with this targeted therapy (e.g. acne-like rash, hand-foot skin reaction, hair changes, and paronychia). In addition, photosensitivity reactions may affect more than one third of treated patients. We report here 2 patients developing photosensitivity reactions with vandetanib therapy, including photoonycholysis. Our patients presented a wide range of phototoxic reactions with exaggerated sunburn reactions solely located to photoexposed areas or hyperpigmentation with visible blue dots. More importantly, both patients concomitantly developed nail changes consistent with type 1 photoonycholysis, which had never been reported so far neither with vandetanib therapy nor with other anticancer-targeted therapies. In addition, histopathologic findings and reflectance confocal microscopy imaging performed in one patient suffering from photodistributed skin hyperpigmentation both strengthen the likelihood of a postinflammatory mechanism. Clinicians should be aware of these underestimated but very characteristic photoinduced adverse events, which can lead to treatment interruption and require very strict photoprotective measures in treated patients.
Insights
Vandetanib therapy can cause significant photosensitivity reactions, including rare nail changes like photoonycholysis. Patients require strict sun protection to manage these adverse events during cancer treatment.
Area of Science:
- Oncology
- Dermatology
- Pharmacology
Background:
- Vandetanib is an oral multitargeted tyrosine kinase inhibitor for advanced or metastatic medullary thyroid cancer.
- Skin toxicities, including photosensitivity, are common adverse events associated with vandetanib therapy.
- Photosensitivity reactions affect over one-third of patients receiving vandetanib.
Purpose of the Study:
- To report two cases of photosensitivity reactions, including photoonycholysis, associated with vandetanib therapy.
- To highlight previously unreported nail changes in patients treated with vandetanib.
- To increase clinician awareness of photoinduced adverse events and the need for photoprotection.
Main Methods:
- Case report of two patients treated with vandetanib for medullary thyroid cancer.
- Clinical observation of phototoxic reactions, including exaggerated sunburn and hyperpigmentation.
- Histopathologic examination and reflectance confocal microscopy of skin lesions in one patient.
Main Results:
- Both patients developed photosensitivity reactions, including exaggerated sunburn and hyperpigmentation.
- Both patients exhibited nail changes consistent with type 1 photoonycholysis, a novel finding for vandetanib.
- Histopathology and confocal microscopy suggested a postinflammatory mechanism for photodistributed hyperpigmentation.
Conclusions:
- Vandetanib therapy can induce significant photosensitivity reactions, including unique nail changes (photoonycholysis).
- Clinicians must be aware of these characteristic photoinduced adverse events to ensure appropriate patient management.
- Strict photoprotective measures are essential for patients undergoing vandetanib treatment to prevent or mitigate these reactions.
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