Cutaneous toxicities with systemic anti-cancer drugs

Molecular targeted therapy mechanism

• Target recurrent oncogenic driver mutations of aberrations

• Small molecule agents or therapeutic monoclonal antibodies acting as signal transduction inhibitors

• Fundamental backbone in precision medicine for cancer treatment, used clinically as first-line therapy for various types of human cancer

• “Off-target effect” or unintended drug targets that caused toxicity by unexpected cross-reactivity with normal cells

• Erupção acneiforme

EGFR associated extra facial skin manifestations

• Paronychia and pyogenic granuloma-like lesions

• Prevention

• Correct nail curve and chiropodist

• Unique granuloma: local destruction

• Multiples
• Tapping and other techniques to correct nail curve, topical beta-blockers

Photosensitivity

• Associated with vemurafenib only (not shared with other BRAF inhibitors)

Vitiligo-like lesions

• Associated with cyclin-dependent kinase 4 and 6 inhibitors

Toxidermia exantematica

• Atarax

• Corticoide tópico

• Corticoide sistémico até 10mg/kg/dia

Immune checkpoint inhibitors

Algoritmo

Stomatitis

• Mechanism
• Direct effect (oral mucosa has high mitotic index)
• Indirect: superimposed infection (ex. candida)

Erythrodysesthesia

• Treatment
• Reduction in chemotherapy dose
• Analgesia
• Topical corticosteroids
• High dose vitamin D
• Low dose acitretin for hyperkeratosis
• Regional cooling for preventive measure

Neutrophilic Eccrine Hidradenitis