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Unusual acute and delayed skin reactions during and after whole-brain radiotherapy in combination with the BRAF inhibitor vemurafenib

Two case reports

Ungewöhnliche akute und verzögerte Hautreaktionen während und nach Ganzhirnbestrahlung in Kombination mit dem BRAF-Inhibitor Vemurafenib

Zwei Fallberichte

  • Case study
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Background

Besides radiotherapy (RT) and surgery, the introduction of BRAF inhibitors like vemurafenib has provided new opportunities for treatment of patients with metastasized malignant melanomas. RT and vemurafenib are being increasingly used concurrently, although little is known about the potential side effects of this combination. Vemurafenib is known to cause severe cutaneous skin reactions such as phototoxicity and evidence is accumulating that RT may further enhance these side effects.

Patients and methods

We report two cases of unusual skin reactions occurring during and after treatment with a combination of vemurafenib and whole-brain irradiation in patients with cerebral metastases arising from malignant melanomas.

Results

One case report describes excessive acute radiodermatitis which arose during whole-brain irradiation in combination with vemurafenib. The second describes a late skin reaction occurring approximately 30 days after completion of RT.

Conclusion

These two case reports show that combination of both treatment modalities is possible, but requires close monitoring of patients and good interdisciplinary collaboration.

Zusammenfassung

Hintergrund

Neben der Strahlentherapie und Chirurgie stellt die Einführung von BRAF-Inhibitoren wie Vemurafenib eine neue Möglichkeit zur Behandlung von metastasierten malignen Melanomen dar und immer häufiger kommt eine Kombination aus Strahlentherapie und Vemurafenib zum Einsatz. Bislang ist wenig bekannt über potentielle Nebenwirkungen, die sich aus einer Kombination beider Therapieoptionen ergeben können. Vemurafenib kann zu schweren kutanen Nebenwirkungen wie z. B. Phototoxizität führen und es häufen sich Hinweise, dass die Strahlentherapie diese Nebenwirkungen verstärken kann.

Patienten und Methoden

Wir berichten über zwei Fälle ungewöhnlicher Hautreaktionen während und nach einer Ganzhirnbestrahlung in Kombination mit Vemurafenib.

Ergebnisse

Ein Fall beschreibt eine akute und überschießende Radiodermatitis unter fortlaufender Radiotherapie und der andere Fall beschreibt eine späte Hautreaktion, welche ca. 30 Tage nach Ende der Bestrahlung auftrat.

Schlussfolgerung

Diese Fälle zeigen, dass eine Kombination beider Therapiemodalitäten möglich ist, aber einer engmaschigen Betreuung dieser Patienten und einer guten interdisziplinären Zusammenarbeit bedarf.

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Funding

The work had no specific funding.

Compliance with ethical guidelines

Conflict of interest. B. Schulze, M. Meissner, M. Wolter, C. Rödel and C. Weiss state that there are no conflicts of interest.

Consent was obtained from all patients identifiable from images or other information within the manuscript. In the case of underage patients, consent was obtained from a parent or legal guardian.

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Authors and Affiliations

  1. Department of Radiation Oncology, Johann Wolfgang Goethe-University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    B. Schulze MD, C. Rödel & C. Weiss

  2. Department of Dermatology, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main, Germany

    M. Meissner & M. Wolter

Authors
  1. B. Schulze MD
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  2. M. Meissner
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  3. M. Wolter
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  4. C. Rödel
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  5. C. Weiss
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Corresponding author

Correspondence to B. Schulze MD.

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Schulze, B., Meissner, M., Wolter, M. et al. Unusual acute and delayed skin reactions during and after whole-brain radiotherapy in combination with the BRAF inhibitor vemurafenib. Strahlenther Onkol 190, 229–232 (2014). https://doi.org/10.1007/s00066-013-0474-3

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  • DOI: https://doi.org/10.1007/s00066-013-0474-3

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