Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; SUNY Downstate College of Medicine, Brooklyn, New York.
University of Massachusetts Medical School, Worcester, Massachusetts.
J Am Acad Dermatol. 2019 Mar;80(3):608-616. doi: 10.1016/j.jaad.2018.10.039. Epub 2018 Oct 26.
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.
严重皮肤不良反应（SCARs）在住院肿瘤患者中很常见。早期干预可能会降低发病率、死亡率和住院费用；然而，目前的临床和组织学特征并不可靠的 SCAR 预测指标。因此，有必要确定能够导致有效治疗干预的合理的 SCAR 标志物。
描述发生 SCAR 的住院癌症患者的临床和血清学特征。
回顾性分析了 49 例患有麻疹样皮疹的住院癌症患者，记录了他们的血清细胞因子（白细胞介素 [IL] 6、IL-10 和肿瘤坏死因子 [TNF] α）或弹性蛋白酶检测结果，以及先前的皮肤科会诊情况。患者分为单纯麻疹样皮疹无全身受累和复杂麻疹样皮疹伴全身受累。
在皮肤科会诊后 6 个月，49 例患者中有 15 例（30.6%）死亡。与仍存活 6 个月的患者相比，死亡患者的弹性蛋白酶、IL-6 和 TNF-α水平显著更高。与药物相关的复杂皮疹患者的 IL-6 和 IL-10 水平显著更高。
回顾性设计、样本量有限和高危患者人群。
在发生 SCAR 的癌症患者中，弹性蛋白酶、IL-6 和 TNF-α 水平可能预示不良预后。针对这些靶点的药物可能代表预防致命性 SCAR 的合理治疗方法。
