暂无摘要。

Antibody-drug conjugates (ADCs) are a new and emerging category of oncologic treatments that combine the target specificity of a monoclonal antibody with a cytotoxic payload. These drugs are associated with unique cutaneous toxicities that vary across agents. Currently, there are eleven ADCs with regulatory approval for solid and liquid tumors and over 80 ADCs currently in clinical development, it is critical for dermatologists to recognize and appropriately mitigate the cutaneous toxicities associated with these therapies. This clinical review will summarize the novel mechanisms and indications of approved ADCs, discuss dermatologic toxicities demonstrated in clinical trials and post-marketing studies, and impart recognition and management guidance when encountering these reactions to help maintain patients safely and comfortably on their medications.

Antibody-drug conjugates (ADCs) are an emerging class of anticancer agents that combine targeting antibodies with potent cytotoxic agents. Their molecular configuration allows for increased therapeutic efficacy and reduced adverse-effect profiles compared to monoclonal antibodies or cytotoxic chemotherapy alone. ADCs cause off-target toxicities through several mechanisms, including premature deconjugation of the cytotoxic agent in the serum and the presence of the targeted antigen on normal tissues. Given cutaneous adverse events comprise 31.3% of all-grade adverse events in clinical trials involving ADCs, dermatologists are increasingly called upon to manage the cutaneous toxicities caused by these drugs. In this review, we summarize known cutaneous toxicities of the ADCs that have been approved for use by the US Food and Drug Administration to date. Dermatologists can play a key role in recognizing cutaneous reactions associated with ADCs, contributing to guidelines for their management, and aiding during clinical trials to generate detailed morphologic and histopathologic descriptions of cutaneous toxicities caused by ADCs.

OBJECTIVE: The clinical outcomes associated with cutaneous toxicity and changes in the renal function of patients receiving enfortumab vedotin (EV) for advanced urothelial carcinoma (UC) is unclear.
METHODS: We retrospectively analyzed the relationship between clinical outcomes and EV-related cutaneous toxicity, and the influence on the renal function in 58 patients with advanced UC who received EV after the failure of platinum-based chemotherapy and immune checkpoint inhibitors from December 2021 to July 2023.
RESULTS: There were no differences in the overall response and disease control rates between patients with any grade of EV-related cutaneous toxicity and without (p=0.605 and p>0.99, respectively) nor of grade ≥3 (p>0.99 and p=0.173, respectively). Progression-free survival was not significantly associated with EV-related cutaneous toxicity of any grade (5.4 vs. 5.6 months, p=0.557) nor of grade ≥3 (2.7 vs. 5.6 months, p=0.053). Overall survival was not significantly associated with EV-related cutaneous toxicity of any grade (11.8 vs. 8.9 months, p=0.389), nor of grade ≥3 (4.6 vs. 11.4 months, p=0.168). The incidence of EV-related cutaneous toxicity of any grade was significantly higher in patients with any grade of ICI-related cutaneous toxicity (88.9% vs. 36.7%, p=0.008). There was no significant difference in the serum creatinine levels after EV treatment (p=0.211). Divided into two groups according to their renal function, using a serum creatinine cut-off of 2 mg/dl, there were no significant changes after EV treatment in either group (p=0.187 and p=0.938).
CONCLUSIONS: EV-related cutaneous toxicity did not affect clinical outcomes, although it occurred in patients who experienced immune checkpoint inhibitor-related cutaneous toxicity. EV did not affect renal function.

BACKGROUND: Hand-foot syndrome (HFS) and nail changes are frequent adverse events of anticancer therapies.
OBJECTIVE: To provide a review of current evidence in HFS and nail disorders associated with medical tumor treatment.
METHODS: Basis is the current German S3 guideline \"Supportive therapy in oncologic patients\" and literature on this topic published since the guideline was finalized.
RESULTS: Two variants of HFS are distinguished: a chemotherapy-associated and a kinase-inhibitor-associated variant. In the first form, painful erythema, blisters and ulceration can occur, also in other areas with a high number of sweat glands such as axillary and inguinal regions. Thus, the secretion of toxic substances through sweat glands is a proposed pathogenetic mechanism. For the second form, which results in callus-like painful thickening of the horny layer on areas of mechanic pressure, a vascular mechanism is proposed. For prophylaxis of HFS, avoidance of mechanical stress, regular cleaning of predisposed areas, and also urea- and diclofenac-containing ointments are recommended; in case of infusions (taxanes, doxorubicine), cooling of hands and feet during infusion is recommended. In case of manifest HFS, dose reduction or prolongation of intervals of the associated treatment are recommended. Nail changes often develop under therapy with chemotherapeutic agents but also under treatment with agents such as checkpoint inhibitors or under targeted therapy. Different components of the nail unit may be involved such as the nail matrix, nail bed, nail plate, hyponychium, lunula and proximal and lateral nail folds.
CONCLUSIONS: This work gives insight into the pathophysiology of HFS and nail disorders that develop under systemic oncologic treatments and gives recommendations for prophylaxis and treatment.
UNASSIGNED: HINTERGRUND: Bestimmte medikamentöse Tumortherapien verursachen kutane Toxizität an Händen, Füßen und Nägeln.
UNASSIGNED: Es erfolgt eine Zusammenfassung der Evidenz zum Tumortherapie-assoziierten Hand-Fuß-Syndrom (HFS) und zu Nagelveränderungen.
METHODS: Grundlage ist die aktuelle deutsche S3-Leitlinie „Supportive Therapie bei onkologischen PatientInnen“. Eine neue Literaturrecherche nach Abschluss der Leitlinie wurde zusätzlich durchgeführt.
UNASSIGNED: Bei dem HFS werden 2 Varianten unterschieden, eine Chemotherapie-assoziierte und eine Kinaseinhibitor-assoziierte Variante. Im ersten Fall kommt es zu schmerzhaften Rötungen, Blasen und Ulzerationen, und es können auch andere schweißdrüsenreiche Areale (Achseln, Leisten) betroffen sein, und man nimmt eine Ausscheidung toxischer Substanzen über den Schweiß an. Im zweiten Fall kommt es zu kallusartiger schmerzhafter Verdickung der Hornschicht an mechanisch belasteten Arealen, und es gibt Hinweise für eine vaskuläre Schädigung. Zur Prophylaxe werden mechanische Entlastung, regelmäßige Reinigung und Harnstoff- oder Diclofenac-haltige Salben empfohlen, bei Infusionen (Taxane, Doxorubicin) Kühlung der Hände und Füße während der Infusion. Sollte trotzdem ein HFS auftreten, sollte eine Dosisreduktion oder Intervallverlängerung der auslösenden Therapie erfolgen. Nagelveränderungen treten v. a. unter Chemotherapien auf, können aber auch unter immunonkologischen Therapien mit z. B. Checkpointinhibitoren oder zielgerichteter Therapie manifest werden. Sie umfassen weiße oder pigmentierte Veränderungen, Rillen- oder Furchenbildung sowie brüchige und sich ablösende Nägel und Entzündungen des Nagelbetts.
CONCLUSIONS: Die Arbeit zeigt die Pathophysiologie von HFS und Nagelveränderungen unter onkologischen Systemtherapien auf und gibt Empfehlungen zu deren Prophylaxe und Therapie.

暂无摘要。

Epidermal growth factor receptor inhibitors (EGFRIs) induced cutaneous toxicity is a common adverse event (AE), although it is not as severe as major cancers, we still need to pay enough attention to them. Therefore, it is necessary to evaluate the diversity of EGFRI class drugs. The objective of this study was to conduct a scientific and systematic investigation into the correlation between EGFRI and cutaneous toxicities. The data accessed from the FDA adverse event reporting system database (FAERS) encompass a time frame spanning from January 2013 to March 2023. By utilizing reporting odds ratios (RORs), information components (ICs), proportional reporting ratios (PRRs), and chi-squared (χ2), the relationship between drugs and adverse reactions was evaluated through disproportionality analysis. Within the FAERS database, a total of 29,559 skin adverse events were recorded. A robust indication of the correlation between EGFRI and elderly patients (≥65 years) was identified. Among EGFRIs, erlotinib accounted for the largest proportion of skin adverse events (39.72%). Rash, dry skin, and pruritus ranked top among all preferred terms, and signals such as rash, skin lesions, and acneiform dermatitis were detected in every single drug. Clinicians should guide patients customize the treatment plan for each patient.

Erythema nodosum (EN) is a type of panniculitis occurring due to various conditions. It can be associated with certain malignancies or manifest as a side effect of drugs. This article presents a unique case of EN in a patient with chronic myeloid leukemia (CML-blast phase) following dasatinib and chemotherapy. Timely recognition and appropriate management are crucial to alleviate symptoms and consider potential drug-induced etiology.

OBJECTIVE: To investigate the effect of borneol on cutaneous toxicity of gilteritinib and to explore possible compounds that can intervene with the cutaneous toxicity.
METHODS: C57BL/6J male mice were given gilteritinib by continuous gavage for 28 d and the damage to keratinocytes in the skin tissues was observed with hematoxylin and eosin (HE) staining, TUNEL assay and immunohistochemistry. Human keratinocytes HaCaT were treated with gilteritinib, and cell death and morphological changes were examined by SRB staining and microscopy; apoptosis of HaCaT cells was examined by Western blotting, flow cytometry with propidium iodide/AnnexinⅤ double staining and immunofluorescence; the accumulation of cellular reactive oxygen species (ROS) was examined by flow cytometry with DCFH-DA. Compounds that can effectively intervene the cutaneous toxicity of gilteritinib were screened from a natural compound library using SRB method, and the intervention effect of borneol on gilteritinib cutaneous toxicity was further investigated in HaCaT cells and C57BL/6J male mice.
RESULTS: In vivo studies showed pathological changes in the skin with apoptosis of keratinocytes in the stratum spinosum and stratum granulosum in the modeling group. Invitro studies showed apoptosis of HaCaT cells, significant up-regulation of cleaved poly (ADP-ribose) polymerase (c-PARP) and gamma-H2A histone family member X (γ-H2AX) levels, and increased accumulation of ROS in gilteritinib-modeled skin keratinocytes compared with controls. Screening of the natural compound library revealed that borneol showed excellent intervention effects on the death of HaCaT cells. In vitro, cell apoptosis was significantly reduced in the borneol+gilteritinib group compared to the gilteritinib control group. The levels of c-PARP, γ-H2AX and ROS in cells were significantly decreased. In vivo, borneol alleviated gilteritinib-induced skin pathological changes and skin cell apoptosis in mice.
CONCLUSIONS: Gilteritinib induces keratinocytes apoptosis by causing intracellular ROS accumulation, resulting in cutaneous toxicity. Borneol can ameliorate the cutaneous toxicity of gilteritinib by reducing the accumulation of ROS and apoptosis of keratinocytes in the skin tissue.
目的: 研究吉列替尼皮肤毒性的发生机制并寻找有效干预策略。方法: 对C57BL/6J雄性小鼠连续28 d灌胃给予吉列替尼，通过皮肤形态观察、苏木精-伊红染色、TUNEL检测、免疫组织化学法检测小鼠皮肤组织角质形成细胞损伤情况。对人角质形成细胞HaCaT给予吉列替尼，通过磺酰罗丹明B（SRB）染色法和显微镜观察法考察细胞死亡和形态学变化；蛋白质印迹法、流式细胞术结合碘化丙啶/Annexin Ⅴ双染法、免疫荧光技术考察吉列替尼作用下HaCaT细胞凋亡情况；流式细胞术结合2 ´ ，7 ´-二氯荧光黄双乙酸盐（DCFH-DA）法考察细胞活性氧累积情况。采用SRB染色法筛选天然化合物库中能有效干预吉列替尼皮肤毒性的天然化合物。HaCaT细胞给予吉列替尼和/或冰片联合处理，考察冰片对吉列替尼皮肤毒性的体外干预效果。C57BL/6J雄性小鼠连续灌胃给予吉列替尼和/或冰片28 d，考察冰片对吉列替尼皮肤毒性的体内干预效果。结果: 体内研究中，组织病理学检查结果提示吉列替尼皮肤毒性造模成功，且模型组雄性小鼠皮肤发生病理性改变，棘层和颗粒层角质形成细胞发生凋亡。体外研究中，与正常对照组比较，吉列替尼模型组发生凋亡、切割型多腺苷二磷酸核糖聚合酶（c-PARP）和磷酸化组蛋白H2AX（γ-H2AX）水平显著上调，活性氧累积明显增多。在天然化合物库中筛选发现冰片对HaCaT细胞死亡显示出极好的干预效果。在体外，相较于吉列替尼对照组，冰片+吉列替尼组凋亡明显减少，细胞中c-PARP、γ-H2AX及活性氧水平显著下降。在体内，冰片可缓解吉列替尼诱导的雄性小鼠皮肤病理性改变和皮肤细胞凋亡。结论: 吉列替尼通过引起细胞内活性氧累积诱导角质形成细胞凋亡，导致皮肤毒性损伤。冰片可以通过减少活性氧累积和皮肤角质形成细胞凋亡，缓解吉列替尼的皮肤毒性作用。.

暂无摘要。