Hand ulcers and cutaneous leucocytoclastic vasculitis secondary to cabozantinib treatment for renal cell carcinoma

Melgosa Ramos, Francisco Javier; Estebánez Corrales, Andrea; Mateu Puchades, Almudena

doi:10.1016/j.medcli.2021.09.024

array:24 ["pii" => "S0025775321006333" "issn" => "00257753" "doi" => "10.1016/j.medcli.2021.09.024" "estado" => "S300" "fechaPublicacion" => "2022-06-10" "aid" => "5834" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2022;158:e4-e5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "en" => array:19 [ "pii" => "S2387020622002534" "issn" => "23870206" "doi" => "10.1016/j.medcle.2022.05.008" "estado" => "S300" "fechaPublicacion" => "2022-06-10" "aid" => "5834" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2022;158:e4-e5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Hand ulcers and cutaneous leucocytoclastic vasculitis secondary to cabozantinib treatment for renal cell carcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e4" "paginaFinal" => "e5" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones ulcerosas en manos y vasculitis leucocitoclástica secundarias al tratamiento con cabozantinib por carcinoma renal" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1022 "Ancho" => 950 "Tamanyo" => 99929 ] ] "descripcion" => array:1 [ "en" => "(A) Cabozantinib induced leukocytoclastic vasculitis. (B) Cabozantinib induced ulcers on the hands associated with palmar erythrodysestesia." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco Javier Melgosa Ramos, Andrea Estebánez Corrales, Almudena Mateu Puchades" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Melgosa Ramos" ] 1 => array:2 [ "nombre" => "Andrea" "apellidos" => "Estebánez Corrales" ] 2 => array:2 [ "nombre" => "Almudena" "apellidos" => "Mateu Puchades" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0025775321006333" "doi" => "10.1016/j.medcli.2021.09.024" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321006333?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622002534?idApp=UINPBA00004N" "url" => "/23870206/0000015800000011/v1_202206190623/S2387020622002534/v1_202206190623/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0025775321006679" "issn" => "00257753" "doi" => "10.1016/j.medcli.2021.09.036" "estado" => "S300" "fechaPublicacion" => "2022-06-10" "aid" => "5857" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2022;158:e6-e7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "Carta al Editor" "titulo" => "Efectividad de rituximab en un caso de fibroelastosis pleuropulmonar en paciente con artritis reumatoide" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e6" "paginaFinal" => "e7" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Effectiveness of rituximab in a case of pleuropulmonary fibroelastosis in a patient with rheumatoid arthritis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1095 "Ancho" => 2007 "Tamanyo" => 468950 ] ] "descripcion" => array:1 [ "es" => "A y B) Lesión homogénea subpleural delimitada bruscamente del parénquima sano (H&E A: ×1; B: ×5). C) Fibras elásticas en paredes alveolares (Verhoeff ×20). D) Fibras colágenas en la luz alveolar (tricrómico de Masson ×20)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miriam Navidad-Fuentes, María Ramírez de la Torre, Susana Quirosa-Flores" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Miriam" "apellidos" => "Navidad-Fuentes" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Ramírez de la Torre" ] 2 => array:2 [ "nombre" => "Susana" "apellidos" => "Quirosa-Flores" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020622002224" "doi" => "10.1016/j.medcle.2021.09.024" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622002224?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321006679?idApp=UINPBA00004N" "url" => "/00257753/0000015800000011/v1_202206040548/S0025775321006679/v1_202206040548/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0025775321006448" "issn" => "00257753" "doi" => "10.1016/j.medcli.2021.09.029" "estado" => "S300" "fechaPublicacion" => "2022-06-10" "aid" => "5845" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2022;158:e2-e3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "Carta al Editor" "titulo" => "Respuesta" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e2" "paginaFinal" => "e3" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Reply" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Luisa Lozano Almela, Miguel Ángel Sanz Alonso, Vicente Vicente García" "autores" => array:3 [ 0 => array:2 [ "nombre" => "María Luisa" "apellidos" => "Lozano Almela" ] 1 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "Sanz Alonso" ] 2 => array:2 [ "nombre" => "Vicente" "apellidos" => "Vicente García" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020622002212" "doi" => "10.1016/j.medcle.2021.09.023" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622002212?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321006448?idApp=UINPBA00004N" "url" => "/00257753/0000015800000011/v1_202206040548/S0025775321006448/v1_202206040548/es/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Hand ulcers and cutaneous leucocytoclastic vasculitis secondary to cabozantinib treatment for renal cell carcinoma" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e4" "paginaFinal" => "e5" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Francisco Javier Melgosa Ramos, Andrea Estebánez Corrales, Almudena Mateu Puchades" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Francisco Javier" "apellidos" => "Melgosa Ramos" "email" => array:1 [ 0 => "javimelgo20172@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Andrea" "apellidos" => "Estebánez Corrales" ] 2 => array:2 [ "nombre" => "Almudena" "apellidos" => "Mateu Puchades" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, University Hospital Doctor Peset of Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones ulcerosas en manos y vasculitis leucocitoclástica secundarias al tratamiento con cabozantinib por carcinoma renal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1022 "Ancho" => 950 "Tamanyo" => 99929 ] ] "descripcion" => array:1 [ "en" => "(A) Cabozantinib induced leukocytoclastic vasculitis. (B) Cabozantinib induced ulcers on the hands associated with palmar erythrodysestesia." ] ] ] "textoCompleto" => "Cabozantinib is a small molecule approved for the treatment of metastatic/advanced renal cell carcinoma and medullary thyroid carcinoma. It is a multikinase inhibitor targeting VEGF 2 receptor, mesenchymal–epithelial transition receptor, and a receptor tyrosine kinase.<a class="elsevierStyleCrossRef" href="#bib0030">1</a> However, cabozantinib, is associated with diverse toxicities that may affect patient's quality of life. The most frequent adverse events are diarrhea, asthenia, hypertension, weight loss and stomatitis but also cutaneous reactions (in over 70% of patients in some series). On this topic we present the case of a 77-year-old male treated with cabozantinib 60mg daily because of metastatic kidney cancer who presented 15 days after cabozantinib prescription bilateral, symmetric non desquamative annular macules over his both lower legs suggesting vasculitis or pigmented purpuric dermatosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). He also referred symmetric ulcers on the hands from the beginning of the treatment, associated with palmar erythrodysestesia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). A skin biopsy of the leg with direct immunoflurescence was taken confirming the diagnosis of leukocytoclastic vasculitis. After discussing the patient with the oncologist, we decided to stop cabozantinib temporarily with cutaneous improvement in two weeks.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Hand–foot skin reaction is an important and very well-known dose-limiting dermatological adverse event caused by cabozantinib are characterized by bilateral, painful, localized calluslike hyperkeratosis with surrounding edema and erythema primarily affecting palmoplantar surfaces).<a class="elsevierStyleCrossRefs" href="#bib0035">2,3</a> Patients receiving this drug can also develop other cutaneous toxic effects as partial hair despigmentation, pigment dilution of the skin (commonly reversible), bullae, hyperkeratosis and erythema of plantar or palmar surfaces, xerosis, scrotal erythema/ulceration, nail splinter hemorrhages or vasculitis as our patient. Most reactions usually take place in the first two months, and commonly require cabozantanib dose reduction and in some cases, treatment discontinuation.<a class="elsevierStyleCrossRefs" href="#bib0045">4,5</a> The mechanism that induces cabozantinib leukocytoclastic vasculitis is unknown, but may be dose-dependent. Some authors have considered different mechanism as direct effect of vascular endothelial growth factor inhibition, immune complex deposition, or also a paraneoplastic phenomenon resulting from antigen exposure from the tumor. To conclude, it is important for oncologist and dermatologist to know the most common cutaneous toxicities derived from novel therapies (TKIs, checkpoint inhibitors etc) in order to anticipate severe reactions and achieve a correct management.Informed consentAll informed consents are available.Data availabilityAll data are available.FundingThis research received no specific grant from any funding agency in the public or private sector.Author's contributionAll authors have contributed to this researchConflict of interestNone." "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Informed consent" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Data availability" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Author's contribution" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 5 => array:2 [ "identificador" => "xack608665" "titulo" => "Acknowledgements" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1022 "Ancho" => 950 "Tamanyo" => 99929 ] ] "descripcion" => array:1 [ "en" => "(A) Cabozantinib induced leukocytoclastic vasculitis. (B) Cabozantinib induced ulcers on the hands associated with palmar erythrodysestesia." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of adverse events associated with cabozantinib therapy in renal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Schmidinger" 1 => "R. Danesi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1634/theoncologist.2017-0335" "Revista" => array:6 [ "tituloSerie" => "Oncologist" "fecha" => "2018" "volumen" => "23" "paginaInicial" => "306" "paginaFinal" => "315" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29146618" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence and risk of hand–foot skin reaction with cabozantinib, a novel multikinase inhibitor: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V.R. Belum" 1 => "C. Serna-Tamayo" 2 => "S. Wu" 3 => "M.E. Lacouture" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ced.12694" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2016" "volumen" => "41" "paginaInicial" => "8" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26009777" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The hand–foot-syndrome associated with medical tumortherapy—classification and management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Degen" 1 => "M. Alter" 2 => "F. Schenck" 3 => "I. Satzger" 4 => "B. Völker" 5 => "A. Kapp" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Dtsch Dermatol Ges" "fecha" => "2010" "volumen" => "8" "paginaInicial" => "652" "paginaFinal" => "661" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous adverse effects associated with the tyrosine-kinase inhibitor cabozantinib" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.C. Zuo" 1 => "A.B. Apolo" 2 => "J.J. DiGiovanna" 3 => "H.L. Parnes" 4 => "C.M. Keen" 5 => "S. Nanda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2014.2734" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2015" "volumen" => "151" "paginaInicial" => "170" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25427282" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous leucocytoclastic vasculitis secondary to cabozantinib therapy for renal cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G.S. Coltart" 1 => "J.E. Sutton" 2 => "H.J. Roche" 3 => "M.P. Sommerlad" 4 => "S.J. Crabb" 5 => "E. Healy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ced.14541" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2021" "volumen" => "46" "paginaInicial" => "739" "paginaFinal" => "740" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33332666" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack608665" "titulo" => "Acknowledgements" "texto" => "Thanks for doctor Héctor Gegúndez Hernández, to be present during the diagnosis." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000015800000011/v1_202206040548/S0025775321006333/v1_202206040548/en/main.assets" "Apartado" => array:4 [ "identificador" => "66430" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas al Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000015800000011/v1_202206040548/S0025775321006333/v1_202206040548/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775321006333?idApp=UINPBA00004N"]

ISSN: 0025-7753

Medicina Clínica, fundada en 1943, es la única publicación semanal de contenido clínico que se edita en España y constituye el máximo exponente de la calidad y pujanza de la medicina española. Son características fundamentales de esta publicación el rigor científico y metodológico de sus artículos, la actualidad de los temas y, sobre todo, su sentido práctico, buscando siempre que la información sea de la mayor utilidad en la práctica clínica. Los contenidos de Medicina Clínica abarcan dos frentes: trabajos de investigación original rigurosamente seleccionados atendiendo a su calidad, originalidad e interés, y trabajos orientados a la formación continuada, encomendados por la revista a autores relevantes (Editoriales, Revisiones, Conferencias clínicas y clínico-patológicas, Diagnóstico y Tratamiento). En estos artículos se ponen al día aspectos de destacado interés clínico o conceptual en la medicina actual. Medicina Clínica es un vehículo de información científica de reconocida calidad, como demuestra su inclusión en los más prestigiosos y selectivos índices bibliográficos del mundo.

Ver más Opción Open Access

Indexada en:

Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, ScienceDirect