Erythema multiforme induced by sorafenib for metastatic renal cell carcinoma.

Objective: Sorafenib is one of the few standard agents for metastatic renal cell carcinoma. Although sorafenib-induced erythema multiforme is rarely reported, we evaluated the cases of erythema multiforme induced by sorafenib for metastatic renal cell carcinoma.
Methods: From November 2006 to November 2011, 36 eligible patients who had been treated with sorafenib were enrolled in this study. Patients received sorafenib 200 or 400 mg orally, twice daily, at 12 h intervals, on a continuous dosing schedule. All patients who experienced rash or erythema multiforme underwent a skin biopsy, and the histopathological diagnosis was confirmed.
Results: Twenty-eight patients (78%) experienced a skin reaction of any toxicity grade. Hand-foot skin reactions occurred in 17 (47%), erythema multiforme in 9 (25%), rash/desquamation in 6 (17%) and alopecia in 9 (25%). Skin biopsy was performed and histopathological diagnosis was confirmed for all nine patients (25%) who experienced erythema multiforme. All nine showed a positive reaction to sorafenib on a subsequent patch test.
Conclusions: Sorafenib-induced erythema multiforme may not be rare in Japanese patients. Patients who once showed erythema multiforme after sorafenib treatment are never to be treated with sorafenib again. Patients treated with sorafenib should be monitored carefully, with a multidisciplinary approach. Consultation with a dermatologist is critical because some cases quickly become severe.