Severe Imatinib-Associated Skin Rash in Gastrointestinal Stromal Tumor Patients: Management and Clinical Implications.
OBJECTIVE
This study evaluated the incidence of imatinib-associated skin rash, the interventional outcomes of severe rash, and impact of severe rash on the outcomes of imatinib treatment in gastrointestinal stromal tumor (GIST) patients.


METHODS
A total of 620 patients were administered adjuvant or palliative imatinib for GIST at Asan Medical Center between January 2000 and July 2012. This analysis focused on a group of 42 patients who developed a severe rash requiring major interventions, defined as dose interruption or reduction of imatinib or systemic steroid use.


RESULTS
Of the 620 patients treated with imatinib, 148 patients (23.9%) developed an imatinib-associated skin rash; 42 patients (6.8%) developed a severe rash requiring major intervention. Of these, 28 patients (66.8%) successfully continued imatinib with interventions. Serial blood eosinophil levels during imatinib treatment were associated with skin rash and severity. A significant association was observed between successful intervention and blood eosinophil level at the time of intervention initiation. In metastatic settings, patients with severe rash requiring major interventions tended to show poorer progression-free survival than patients who did not require major intervention and patients with no rash, although this finding was not statistically significant (p=0.326).


CONCLUSIONS
By aggressive treatment of severe rash through modification of imatinib dose or use of systemic steroid, the majority of patients can continue on imatinib. In particular, imatinib dose intensity can be maintained with use of systemic steroid. Measuring the blood eosinophil levels may be helpful in guiding the management plan for skin rash regarding the intensity and duration of interventions.
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Sook Ryun
SR
Park
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Min-Hee
MH
Ryu
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Baek-Yeol
BY
Ryoo
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Mo Youl
MY
Beck
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
In Soon
IS
Lee
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Mi Jung
MJ
Choi
Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Mi Woo
MW
Lee
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Yoon-Koo
YK
Kang
D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005076:Exanthema / Q000139:chemically induced*; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy*; D006801:Humans; D000068877:Imatinib Mesylate / Q000009:adverse effects* / Q000627:therapeutic use
D000970:Antineoplastic Agents; D000068877:Imatinib Mesylate
Eosinophils; Exanthema; Gastrointestinal stromal tumors; Imatinib; Treatment outcome