title: Increased skin and mucosal toxicity in the combination of vemurafenib with radiation therapy.
abstract: BACKGROUND
  Palliative radiotherapy is often required for patients with metastatic malignant melanoma in the case of bone or brain metastases. Since BRAF inhibitor therapy is highly efficient in V600-mutated melanomas, there is hesitation to stop it during radiotherapy. Consequently, radiotherapy under simultaneous vemurafenib treatment is frequently needed.
  
  
  METHODS
  We report the case of a patient receiving palliative radiotherapy of spinal bone metastases before and during vemurafenib therapy. The skin reactions were quantitatively scored using computer-assisted digital image evaluation.
  
  
  RESULTS
  Radiotherapy without vemurafenib was tolerated very well, whereas radiotherapy under simultaneous vemurafenib treatment resulted in accentuated skin reactions. Furthermore, the patient developed dysphagia and had to be hospitalized for parenteral nutrition. In the quantitative analysis, there was a twofold increase in pigmentation and erythema of the irradiated skin area of the thoracic spine when vemurafenib was combined with radiotherapy compared with radiotherapy treatment alone. This is the first reported case of a patient showing no complications during radiotherapy without vemurafenib but remarkable skin and mucosal toxicity under concurrent vemurafenib therapy. Thus, a genetically conditioned individually elevated radiosensitivity can definitely be excluded. Compared with other reported cases, radiosensitization was not limited to the skin, but also affected the esophageal mucosa.
  
  
  CONCLUSIONS
  Vemurafenib is a strong radiosensitizer. Patients receiving radiotherapy under simultaneous vemurafenib treatment should be monitored very closely.
authors: Department of Radiation Oncology University Hospital Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany, ricarda.merten@uk-erlangen.de.
authors: Ricarda
authors: R
authors: Merten
authors: Markus
authors: M
authors: Hecht
authors: Marlen
authors: M
authors: Haderlein
authors: Luitpold
authors: L
authors: Distel
authors: Rainer
authors: R
authors: Fietkau
authors: Lucie
authors: L
authors: Heinzerling
authors: Sabine
authors: S
authors: Semrau
mesh_terms: D000328:Adult; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods*; D004941:Esophagitis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D008297:Male; D052016:Mucositis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D010166:Palliative Care / Q000379:methods; D011855:Radiodermatitis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D011859:Radiography; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D013449:Sulfonamides / Q000627:therapeutic use*; D016896:Treatment Outcome; D000077484:Vemurafenib
chemical_list: D007211:Indoles; D013449:Sulfonamides; D000077484:Vemurafenib