Karri Padmavathi V, Freemyer Benjamin D, Pacha Omar, Patel Anisha B
Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Dermatology, UTHealth McGovern Medical School, Houston, TX, USA.
J Immunother Precis Oncol. 2020 Nov 12;3(4):141-146. doi: 10.36401/JIPO-20-16. eCollection 2020 Nov.
Phosphoinositide 3-kinase (PI3K) inhibitors are a new class of cancer therapeutics that inhibits one or more enzymes in the PI3K/AKT/mTOR tumor growth pathway. As compared to other tyrosine kinase inhibitors, there is evidence that PI3K inhibitors have a higher incidence of severe cutaneous adverse events (CAEs) ranging from 2-21%. There is a lack of further characterization of clinical trials and management options for these CAEs.
A retrospective chart review of our institution's records between January 2015 and May 2019 was conducted; electronic medical records were queried by using a pharmacy database and ICD-10 codes for patients receiving PI3K inhibitor who experienced CAEs during therapy. These CAEs were characterized by two board-certified dermatologists at a major cancer center.
Eleven patients were identified as having 12 cumulative CAEs. Average time to rash onset was 4 weeks, and the most common identified rashes were eczematous (25%) and morbilliform (17%). Four patients experienced a dose delay, and one patient immediately discontinued their PI3K inhibitor.
Although most CAEs caused by PI3K inhibitors in this study were limited to grade 1-2 and were controlled with topical corticosteroids and oral antihistamines, a number of patients experienced dose impact. This highlights the dermatologist's role in managing and minimizing interruption of therapy while maintaining quality of life.
磷酸肌醇3-激酶（PI3K）抑制剂是一类新型癌症治疗药物，可抑制PI3K/AKT/mTOR肿瘤生长途径中的一种或多种酶。与其他酪氨酸激酶抑制剂相比，有证据表明PI3K抑制剂导致严重皮肤不良事件（CAE）的发生率更高，范围在2%至21%之间。目前缺乏对这些CAE的临床试验及管理方案的进一步描述。
对本机构2015年1月至2019年5月期间的记录进行回顾性图表审查；通过药房数据库和ICD-10编码查询接受PI3K抑制剂治疗期间出现CAE的患者的电子病历。这些CAE由一家大型癌症中心的两名获得委员会认证的皮肤科医生进行特征描述。
确定11名患者共有12次CAE。皮疹出现的平均时间为4周，最常见的皮疹类型为湿疹样（25%）和麻疹样（17%）。4名患者出现剂量延迟，1名患者立即停用PI3K抑制剂。
尽管本研究中由PI3K抑制剂引起的大多数CAE仅限于1-2级，且可通过外用糖皮质激素和口服抗组胺药控制，但仍有一些患者出现了剂量影响。这凸显了皮肤科医生在管理和尽量减少治疗中断同时维持生活质量方面的作用。
