Markers of systemic involvement and death in hospitalized cancer patients with severe cutaneous adverse reactions

Publication date: Available online 26 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Shoko Mori, Alanna Hickey, Stephen W. Dusza, Mario E. Lacouture, Alina Markova

Abstract

Background

Severe cutaneous adverse reactions (SCARs) are frequent in inpatient oncology. Early intervention may reduce morbidity, mortality, and hospitalization costs, however current clinical and histologic features are unreliable SCAR predictors. There is a need to identify rational markers of SCARs that could lead to effective therapeutic interventions.

Objective

To characterize the clinical and serologic features of hospitalized patients with cancer who developed SCARs.

Methods

Retrospective review of 49 hospitalized cancer patients with a morbilliform rash and recorded testing for serum cytokines (IL-6, IL-10, TNF-α) or elafin, and prior dermatology consultation. Patients were categorized as having a 'simple' morbilliform rash without systemic involvement or 'complex' morbilliform rash with systemic involvement.

Results

Fifteen out of 49 patients (30.6%) were deceased at 6 months from time of dermatologic consultation. Elafin, IL-6, and TNF-α were significantly higher in patients who died compared to patients who were still alive at 6 months. IL-6 and IL-10 were significantly higher in patients with a drug-related 'complex' rash.

Limitations

Retrospective design, limited sample size, high-risk patient population.

Conclusion

In cancer patients with SCARs, elafin, IL-6, and TNF- α may predict a poor outcome. Agents directed towards these targets may represent rational treatments for the prevention of fatal SCARs.