RESUMO
Vemurafenib is a newly licensed target-directed medication. It has been proven to improve the survival of patients with metastatic melanoma and the BRAF(V600E) mutation; however, adverse cutaneous reactions are frequent. Few cases of life-threatening severe cutaneous adverse reactions (SCARs) induced by vemurafenib have been reported. Dabrafenib, another selective BRAF inhibitor, has been licensed recently as an alternative drug with the same indications. From a molecular point of view, both vemurafenib and dabrafenib contain a sulfonamide group; cross-reactivity to sulfonamide compounds has been reported in allergic patients. We report on a patient with vemurafenib-induced toxic epidermal necrolysis (TEN). In vitro analysis of lymphocyte reactivity to vemurafenib showed positive results, confirming drug causality. In addition, lymphocytes from the patient reacted to dabrafenib and to the antibiotic sulfonamide drug sulfamethoxazole. Moreover, lymphocytes from two patients with cutaneous adverse reactions to sulfamethoxazole also reacted to vemurafenib and dabrafenib in vitro. These data strongly suggest that there might be clinical cross-reactivity between BRAF inhibitors and sulfonamides in some patients. Thus, precautions should be taken to avoid sulfonamide drugs as much as possible in patients showing serious hypersensitivity reactions to vemurafenib and vice versa.
Assuntos
Antineoplásicos/efeitos adversos , Indóis/efeitos adversos , Síndrome de Stevens-Johnson/etiologia , Sulfonamidas/efeitos adversos , Idoso , Interações Medicamentosas , Quimioterapia Combinada , Humanos , Imidazóis/efeitos adversos , Masculino , Melanoma/tratamento farmacológico , Oximas/efeitos adversos , Inibidores de Proteínas Quinases/efeitos adversos , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Piridonas/efeitos adversos , Pirimidinonas/efeitos adversos , Neoplasias Cutâneas/tratamento farmacológico , VemurafenibAssuntos
Antebraço/patologia , Imunoglobulina A , Imunoglobulina G , Cadeias kappa de Imunoglobulina , Paraproteinemias/imunologia , Dermatopatias Vesiculobolhosas/imunologia , Eosinófilos/patologia , Feminino , Humanos , Imunoglobulina A/imunologia , Imunoglobulina G/imunologia , Cadeias kappa de Imunoglobulina/imunologia , Linfócitos/patologia , Pessoa de Meia-Idade , Neutrófilos/patologia , Dermatopatias Vesiculobolhosas/patologiaRESUMO
The efficacy of itraconazole was assessed in an open trial in 30 patients with disseminated lesions of pityriasis versicolor confirmed by direct microscopy. The patients were allocated randomly to one of two treatment regimens, 200 mg once daily for 5 days or 100 mg once daily for 10 days. On assessment 3 weeks after the end of the treatment, 25 patients were healed, two patients had mild residual lesions, two had considerable residual lesions and one patient had relapsed. One patient reported dyspepsia and one patient reported stomach ache. One patient had asymptomatic elevation of serum transaminase (GOT and GPT) but this had returned to normal 3 weeks after the end of therapy.
