Severe cutaneous adverse reactions (SCARs) are frequent in inpatient oncology. Early intervention might reduce morbidity, mortality, and hospitalization costs; however, current clinical and histologic features are unreliable SCAR predictors. There is a need to identify rational markers of SCARs that could lead to effective therapeutic interventions.
To characterize the clinical and serologic features of hospitalized patients with cancer who developed SCARs.
Retrospective review of 49 hospitalized cancer patients with a morbilliform rash, recorded testing for serum cytokines (interleukin [IL] 6, IL-10, and tumor necrosis factor [TNF] α) or elafin, and a prior dermatology consultation. Patients were categorized as having a simple morbilliform rash without systemic involvement or complex morbilliform rash with systemic involvement.
Fifteen out of 49 patients (30.6%) were deceased at 6 months from time of dermatologic consultation. Elafin, IL-6, and TNF-α were significantly higher in patients who died compared with patients who were still alive at 6 months. IL-6 and IL-10 were significantly higher in patients with a drug-related complex rash.
Retrospective design, limited sample size, and high-risk patient population.
In cancer patients with SCARs, elafin, IL-6, and TNF-α levels might predict a poor outcome. Agents directed against these targets might represent rational treatments for the prevention of fatal SCARs.Le texte complet de cet article est disponible en PDF.
Key words : cytokine, drug-induced hypersensitivity syndrome, drug rash, drug reaction, drug reaction with eosinophilia and systemic symptoms, graft versus host disease, severe cutaneous adverse reaction
Abbreviations used : AGEP, DIHS, DRESS, GVHD, IL, NLR, SCAR, SJS, TEN, TNF-α
| Funding sources: Dr Markova is supported by a Dermatology Foundation Career Development Award. This study was supported in part by a grant from the National Cancer Institute, National Institutes of Health, given to the Memorial Sloan Kettering Cancer Center (P30-CA008748).
| Disclosures: Dr Lacouture reported receiving research funding from Berg, Bristol-Myers Squibb, Lutris, Paxman, Novocure, Veloce, and US Biotest and serving as a consultant to Legacy Healthcare Services, Adgero Bio Pharmaceuticals, Amryt Pharmaceuticals, Celldex Therapeutics, Debiopharm, Galderma Research and Development, Johnson and Johnson, Novocure Inc, Lindi, Merck, Sharp and Dohme Corporation, Helsinn Healthcare SA, Janssen Research & Development, LLC, Menlo Therapeutics, Novartis Pharmaceuticals Corporation, F. Hoffmann-La Roche AG, Abbvie, Inc, Boehringer, Ingelheim Pharma Gmbh & Co. KG, Allergan Inc, Amgen Inc, E.R. Squibb & Sons, L.L.C., EMD Serono, Inc, Astrazeneca Pharmceuticals LP, Genentech, Inc, Leo Pharma, Inc, Seattle Genetics, Bayer, Manner SAS, Lutris, Pierre Fabre, Paxman Coolers, Adjucare, Dignitana, Biotechspert, Teva Mexico, Parexel, OnQuality Pharmaceuticals Ltd, Novartis, and Our Brain Bank. Dr Markova reported serving as a consultant to AstraZeneca. No other potential conflicts of interest were disclosed.
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