title: Widespread morbilliform rash due to sorafenib or vemurafenib treatment for advanced cancer; experience of a tertiary dermato-oncology clinic.
abstract: BACKGROUND
  In the literature, there are minimal data for the treatment of grade 2 or 3 morbilliform/atypical target lesion rashes secondary to sorafenib or vemurafenib given for patients with advanced stage cancer. This poses a dilemma for clinicians, particularly in patients with advanced neoplastic disease for whom other optional treatments are limited.
  
  
  METHODS
  The cohort included data on all patients attending the dermato-oncological clinic at a tertiary medical center that presented in 2011-2014 with a widespread rash following treatment with sorafenib or vemurafenib. All patients were prospectively followed.
  
  
  RESULTS
  Eight patients met the study criteria. Five, under sorafenib, aged 50-65 years, presented with an extensive grade 2 (involving 20-30% of the body surface area, two patients) or grade 3 (three patients) morbilliform rash, 5-10 days after onset of the drug. Two had atypical target lesions. The dosage was temporarily reduced in only two patients, and oral steroids were added in four. Under vemurafenib, three patients presented with an extensive grade 3 morbilliform rash 5-10 days after onset of treatment. Two had atypical target lesions. The dose was temporarily reduced in one, and another patient stopped the drug at her own initiative; both also received steroids. The rash subsided after 2-3 weeks in all eight patients, allowing continuation of the treatment at the regular dose.
  
  
  CONCLUSIONS
  Our cohort suggests that not all cases of widespread morbilliform rash or atypical erythema multiforme, which occur under treatment with sorafenib or vemurafenib, given for advanced cancer, require discontinuation of therapy.
authors.affiliation: Department of Dermatology, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Ayelet
authors.initials: A
authors.lastname: Ollech
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Salomon M
authors.initials: SM
authors.lastname: Stemmer
authors.affiliation: Center for Melanoma and Cancer Immunotherapy, Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Merims
authors.affiliation: Center for Melanoma and Cancer Immunotherapy, Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Lotem
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Aron
authors.initials: A
authors.lastname: Popovtzer
authors.affiliation: Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hendler
authors.affiliation: Department of Dermatology, Rabin Medical Center, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Emmilia
authors.initials: E
authors.lastname: Hodak
authors.affiliation: Department of Pathology, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Elena
authors.initials: E
authors.lastname: Didkovsky
authors.affiliation: Department of Dermatology, Rabin Medical Center, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Iris
authors.initials: I
authors.lastname: Amitay-Laish
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology; D005076:Exanthema / Q000139:chemically induced* / Q000628:therapy*; D005260:Female; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D009536:Niacinamide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D010671:Phenylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D000077157:Sorafenib; D013256:Steroids / Q000627:therapeutic use; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects*; D000077484:Vemurafenib
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D010671:Phenylurea Compounds; D013256:Steroids; D013449:Sulfonamides; D000077484:Vemurafenib; D009536:Niacinamide; D000077157:Sorafenib