Lamiaux Marie, Scalbert Camille, Lepesant Pauline, Desmedt Eve, Templier Carole, Dziwniel Véronique, Staumont-Sallé Delphine, Mortier Laurent
Department of Dermatology, Claude Huriez Hospital, CHRU Lille.
Department of Health, Lille 2 University.
Melanoma Res. 2018 Oct;28(5):451-457. doi: 10.1097/CMR.0000000000000472.
Targeted therapy combination (TTC: antiRAF+antiMEK) is known to improve metastatic melanoma survival. Few severe skin toxicities (grade ≥3) are described with first-line TTC (17% for vemurafenib+cobimetinib and none for dabrafenib+trametinib) in a phase III trial. Among our 42 patients treated by TTC between January 2014 and March 2017, 4.8% (2/42) of those treated in the first line presented severe skin rash versus 19% (8/42) of patients treated in the second line after previous immunotherapy. In particular, we observed one case of Stevens-Johnson syndrome and four cases of severe drug reaction with eosinophilia and systemic symptoms syndrome under TTC in patients who had received immunotherapy previously. Thus, previous immunotherapy appears to play an important role in the skin rash onset and severity induced by TTC.
已知靶向治疗联合方案（TTC：抗RAF+抗MEK）可提高转移性黑色素瘤患者的生存率。在一项III期试验中，一线TTC（维莫非尼+考比替尼为17%，达拉非尼+曲美替尼则无）导致的严重皮肤毒性（≥3级）较少。在2014年1月至2017年3月期间接受TTC治疗的42例患者中，一线治疗患者出现严重皮疹的比例为4.8%（2/42），而在先前接受免疫治疗后接受二线治疗的患者中这一比例为19%（8/42）。特别是，我们观察到在先前接受过免疫治疗的患者中，有1例史蒂文斯-约翰逊综合征和4例在TTC治疗下出现的伴有嗜酸性粒细胞增多和全身症状综合征的严重药物反应。因此，先前的免疫治疗似乎在TTC诱导的皮疹发生和严重程度方面起着重要作用。
