Programmed cell death 1 (PD-1) and programmed death-ligand 1 (PD-L1) have emerged as popular targets for immune checkpoint inhibitors given the numerous malignancies that have been found to upregul...
e15031 Background: Temsirolimus, an mTOR inhibitor, is approved for treatment of advanced renal cell carcinoma (RCC). Maculopapular/acneiform rash and stomatitis are the most common mucocutaneous toxicities. We systematically investigated the overall incidence and risk of rash and stomatitis in patients receiving temsirolimus. Methods: Relevant studies were identified from PubMed database (1999-2010) and abstracts presented at the American Society of Clinical Oncology Conferences between 2004 and 2010. A citation database Web of Science was searched to ensure that no relevant studies were missed. Eligible studies were limited to prospective Phase II-III clinical trials and expanded-access programs in which cancer patients received temsirolimus 25 mg weekly as a single agent. Incidence, relative risk (RR), and 95% confidence intervals were calculated using random-effects or fixed-effects models based on heterogeneity of included studies. Results: A total of 579 patients from 10 clinical trials were available for analysis. The overall incidence of all-grade and high-grade (grade ≥3) rash was 46.7% (95% CI: 37.5- 56.1) and 3.2% (95% CI: 1.9-5.3), respectively. The overall incidence of all-grade and high-grade stomatitis was 44.3 % (CI: 32.1- 57.1) and 3.2% (95% CI: 1.9-5.4). Temsirolimus was associated with significantly increased risk of all-grade rash and all-grade stomatitis (RR=7.8, 95% CI: 4.5-13.6; P<0.001 and RR=11.1, 95% CI: 5.6-22.0; P<0.001) when compared to patients treated with IFN. The risk of high-grade rash and stomatitis was increased (RR=13.2, 95% CI: 0.8-219.8 and RR=13.2, 95% CI: 0.8-218.5) with a trend reaching statistical significance (P=0.07). No significant difference in incidence of all-grade rash between RCC and non-RCC patients was noted (42.6%, 95% CI: 18.4-70.9% vs. 47.6%, 95% CI: 39.2-56.2%, respectively, p=0.75). Similarly, no difference in all-grade stomatitis was observed (36.5%, 95% CI: 14.9-65.4% and 47.8%, 95% CI: 35.8-60.1%, respectively, p=0.47). Conclusions: Cancer patients treated with temsirolimus are at significant risk for developing skin rash and stomatitis. Further studies for prevention and treatment of these untoward toxicities are needed.
Over the past decade, there has been a rise in the use of lubricious polymer-coated devices by interventional cardiologists and vascular surgeons to facilitate access to vasculature and for assistance in placement of endovascular devices.1 These devices enable a less invasive technique for common endovascular procedures. Some drug-eluted variants of polymer devices have the added benefit of releasing a sustained amount of targeted therapeutic agents, while reducing systemic complications.2 However, a significant adverse event associated with polymer-coated devices includes coating separation during endovascular manipulation and subsequent embolism formation.
Calciphylaxis, or calcific uremic arteriolopathy, is a rare disorder characterized by calcium deposition in both dermal and subcutaneous adipose tissue as well as in small vessels. It leads to thrombosis, ischemia, and cutaneous necrosis.1 Calciphylaxis is typically seen in the setting of end-stage renal disease, but it has been increasingly reported in patients with preserved renal function and patients with systemic lupus erythematosus (SLE).2-6 We report an unusual, highly aggressive, and rapidly progressive case of fatal nonuremic calciphylaxis with atypical clinical and histopathologic features in a patient with SLE.
Abstract Demodex spp . mites are a common colonizer of sebaceous adult skin. Though usually clinically insignificant, demodicosis may be associated with a wide spectrum of skin diseases in immunocompetent hosts, such as erythematotelangiectatic and papulopustular rosacea, Demodex folliculorum, and blepharitis. We present a case of a healthy 9‐year‐old boy with an exuberant, inflammatory, Demodex ‐associated pustular eruption of the face, induced by the use of a high‐potency topical steroid and successfully treated with oral ivermectin.
The discovery of the intricate intracellular signaling networks that regulate normal cellular proliferation and survival but can also drive the oncogenic process when aberrantly activated has led to the emergence of targeted agents in oncology. The introduction of such agents has resulted in improved survival and more tolerable treatments, reducing systemic toxicities such as myelosuppression. Nevertheless, it has become evident that these agents are associated with a wide spectrum of dermatologic toxicities that often manifest in cosmetically sensitive areas and may affect the majority of patients. Associated pain and pruritus can negatively impact quality of life, resulting in dose modification or treatment interruptions that interfere with potentially life-prolonging therapy. Extensive efforts throughout the past decade have concentrated on describing the clinicohistopathologic characteristics, elucidating the underlying mechanisms, and investigating potential management strategies. Currently, however, proposed treatment guidelines arise from expert opinions, anecdotal evidence, and few data from clinical trials. This article reviews the spectrum of dermatologic toxicities associated with a variety of targeted agents used alone or in combination with other modalities, delineating their clinical presentation, underlying mechanisms, and management options.
