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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 postmarketing studies, and impart recognition and management guidance when encountering these reactions to help maintain patients safely and comfortably on their medications. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Keratinocytic cancers (KCs), specifically cutaneous squamous cell and basal cell carcinomas, can respond to topical, intralesional, or systemic immunotherapies, but cutaneous adverse events (CAEs) may occur. Understanding these risks, early recognition of these CAEs, and effective treatment may enable patients to continue their anticancer immunotherapies without dose impact. Immune checkpoint inhibitor-related CAEs after KCs can have multiple clinical presentations, with specific observed types including psoriasis and bullous pemphigoid. Cutaneous toxicities can require biopsies to confirm the diagnosis, especially in patients who are not responsive to topical or oral steroids, since the selection of biologic drugs depends on accurate diagnosis. Different types of CAEs from immune checkpoint inhibitors have been associated with different oncologic outcomes in various primary cancer types, and this remains to be determined for KC patients. CAE characterization and management after immune checkpoint inhibitors in KC patients is a rapidly growing field that needs specific and prospective studies. [ABSTRACT FROM AUTHOR]

Abstract Background: Skin lesions due to acute methotrexate (MTX) toxicity are rare. The majority of cases of cutaneous MTX toxicity have been reported in patients with psoriasis, exceptionally in patients with rheumatoid arthritis (RA). We report a case of RA who had an acute severe cutaneous MTX toxicity and its management. Case presentation: A 59 year old woman who has been followed up in Rheumatology department in Farhat Hached Hospital in Sousse in Tunisia since 2005 for RA. Since 2005 initially, she was treated with MTX at a dose of 10 mg/week orally that changed in 2014 to the injection route because of gastric intolerance. She also received oral corticosteroids (prednisone: 10 mg/day). In January 2017, she had mucosal and cutaneous erosions, post-bullous affecting the face mostly cheeks and subciliary arches and the forearms. A cutaneous biopsy was performed and showed a histological appearance compatible with photo-aggravated toxiderma with an eroded epidermis, keratinocytic necrosis and the presence of numerous eosinophils in the dermis which is elastosic. The Direct Immunofluorescence study was negative. Based on clinical and histological data, the diagnosis of acute severe cutaneous MTX toxicity was suspected. The patient recovered following MTX withdrawal and using a cicatrizing cream after a duration of 5 months. Treatment with Tocilizumab was started in March 2017. Conclusion: Although MTX is an option of great therapeutic value for RA. Rheumatologists and Dermatologists need to be alert to the possibility of cutaneous adverse events associated with MTX therapy. [ABSTRACT FROM AUTHOR]

The relationship between treatment outcome and cutaneous toxicity induced by anticancer therapy has gained attention in the past decade. In this article, we have provided an overview of the 3 main classes of anticancer agents-specifically, molecularly targeted kinase inhibitors, immune checkpoint inhibitors, and cytotoxic chemotherapeutics-and described the data evaluating the association between cutaneous toxicity induced by these agents and survival benefit. Although preliminary studies are promising with regard to the potential role of cutaneous toxicities as a surrogate biomarker of efficacy of treatment, larger prospective studies are needed to confirm this relationship. Dermatologists have a unique opportunity to collaborate with oncologists in the multidisciplinary treatment paradigm by helping to identify and manage these dermatologic events in patients with cancer. A heightened awareness of these toxicities is critical, as it can potentially allow recognition of the efficacy of anticancer therapy and may influence treatment decisions and patient outcomes. [ABSTRACT FROM AUTHOR]

In this study, cutaneous toxicities associated with the administration of chemotherapy in combination are discussed. Rapidly growing cells are the targets of chemotherapy, so the skin, hair follicles, and nail matrix are frequently affected by chemotherapy. Chemotherapy skin reactions are more likely toxic than allergic reactions. There are numerous chemotherapy-induced cutaneous reactions that have been described in the literature. In addition to a variety of miscellaneous reactions, 19 major cutaneous reactions were discussed in current study. This study was designed to evaluate the clinical spectrum of all cutaneous toxicities over two years in hospitalized and ambulatory patients in the Department of Pediatric oncology and to establish probable relationship between the reaction and suspected anticancer protocol with the help of WHO (World Health Organization) Common Toxicity Criteria by Grade. The data on the cutaneous toxicities were analyzed by percentile and ranking method. The minimal (0.8%) cutaneous adverse effects monitored during the study were Petechiae, photosensitivity, pruritis, urticaria, wound-infection, erythema multiforme, hand-foot skin reaction, injection site reaction, dry skin. Alopecia was the single most common (64.3%) adverse effect observed during the study, where as the pigmentary changes were the second most common (18.2%) adverse effect monitored. While these side effects are generally not life threatening, they can be a source of significant distress to patients, especially alopecia. [ABSTRACT FROM AUTHOR]

Pulsatilla koreana is a plant that grows in Korea and China. A P. koreana extract (PKE) is made from the roots, leaves, and stems and has been used frequently in herbal medicine due to its anti-inflammatory effect. However, PKE can cause irritable contact dermatitis. A 52-year-old woman visited the hospital with painful blisters on both feet after PKE was applied the day before. She had plantar fasciitis on both feet for 4 months and had been told by her neighbors that PKE was a good treatment. Her feet were rinsed with saline to remove the toxin when she arrived at the hospital and were treated with antibacterial cream and an antihistamine. She recovered after 3 weeks with mild pigmentation on both feet. [ABSTRACT FROM AUTHOR]