title: Unusual acute and delayed skin reactions during and after whole-brain radiotherapy in combination with the BRAF inhibitor vemurafenib. Two case reports.
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.
  
  
  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.
  
  
  CONCLUSIONS
  These two case reports show that combination of both treatment modalities is possible, but requires close monitoring of patients and good interdisciplinary collaboration.
authors.affiliation: Department of Radiation Oncology, Johann Wolfgang Goethe-University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany, bj.schulze@gmx.de.
authors.forename: B
authors.initials: B
authors.lastname: Schulze
authors.forename: M
authors.initials: M
authors.lastname: Meissner
authors.forename: M
authors.initials: M
authors.lastname: Wolter
authors.forename: C
authors.initials: C
authors.lastname: Rödel
authors.forename: C
authors.initials: C
authors.lastname: Weiss
mesh_terms: D001932:Brain Neoplasms / Q000556:secondary* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D016371:Cranial Irradiation / Q000009:adverse effects*; D005148:Facial Dermatoses / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects*; D033183:Interdisciplinary Communication; D008297:Male; D008545:Melanoma / Q000556:secondary* / Q000628:therapy*; D008875:Middle Aged; D048493:Proto-Oncogene Proteins B-raf / Q000037:antagonists & inhibitors*; D011855:Radiodermatitis / Q000175:diagnosis / Q000209:etiology*; D011880:Radiotherapy Planning, Computer-Assisted; D012536:Scalp Dermatoses / Q000175:diagnosis / Q000209:etiology*; D012878:Skin Neoplasms / Q000628:therapy*; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects*; D000077484:Vemurafenib
chemical_list: D007211:Indoles; D013449:Sulfonamides; D000077484:Vemurafenib; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf