Necrosis of a skin autograft after short-term treatment with sunitinib in a 14-year-old girl with metastatic alveolar soft part sarcoma of the thigh.
A 14-year-old girl was diagnosed with alveolar soft part sarcoma (ASPS) of the thigh and lung metastases. She underwent tumor resection and pulmonary metastasectomy followed by hyperfractionated local radiotherapy (44.8 Gy). A mesh graft transplant was used to cover the postoperative skin defect on the thigh. Since ASPS do not respond to conventional chemotherapy antiangiogenic treatment with peginterferon alfa-2b and thalidomide was started. Immunohistochemical analysis of tumor tissue showed expression of vascular endothelial growth factor receptors (VEGFR) 1, 2, 3, and platelet derived growth factor receptor (PDGFR)-alpha and -beta. Hence, additional treatment with multitargeted receptor tyrosine kinase inhibitor sunitinib (Sutent) was started on a compassionate use basis. 2 weeks later the patient presented with necrosis of the skin transplant requiring necrectomy and skin grafting. This case illustrates that drugs inhibiting vascular endothelial growth factor receptors have to be used very cautiously in cancer patients with severe pre-existing skin damage.
Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical University of Graz, Graz, Austria. marie.hanzer@medunigraz.at
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Hanzer
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Nebl
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Spendel
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Pilhatsch
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Urban
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Benesch
D000293:Adolescent; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D057176:Compassionate Use Trials; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D009336:Necrosis; D011183:Postoperative Complications / Q000139:chemically induced / Q000473:pathology / Q000601:surgery; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D018234:Sarcoma, Alveolar Soft Part / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D016038:Skin Transplantation; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D000077210:Sunitinib; D013524:Surgical Flaps / Q000098:blood supply* / Q000473:pathology*; D013848:Thigh / Q000601:surgery
D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib