<\/span><\/strong><\/h4>\n<\/span><\/strong><\/h4>\nProf. Univ. Dr. Lucian Miron <\/span><\/strong>
\nUniversitatea de Medicin\u0103 \u0219i Farmacie “Grigore T. Popa\u201d Ia\u015fi
\nInstitutul Regional de Oncologie Ia\u015fi<\/span><\/strong><\/h4>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.25″][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.4.8″ hover_enabled=”0″]<\/p>\n
Efecte secundare dermatologice ale terapiilor sistemice la pacien\u021bii oncologici<\/span>
Autor: Lucian Miron<\/span><\/p>\n\u00cen ultimele decenii, tratamentele oncologice au cunoscut o dezvoltare important\u0103 prin apari\u0163ia de noi agen\u021bi. Printre cele mai frecvente efecte secundare ale terapiilor oncologice sunt \u015fi modific\u0103rile cutanate denumite toxicit\u0103\u021bi dermatologice.
Chimioterapia citotoxic\u0103 conven\u021bional\u0103 continu\u0103 s\u0103 joace un rol important \u00een tratamentul cancerului. Cele mai frecvente manifest\u0103ri adverse cutanate post-chimioterapie sunt: hiperpigmentarea, sindromul m\u00e2n\u0103-picior, recurgerea la radia\u021bii, hipersensibilitate, leziuni de extravazare \u0219i distrofii ale unghiilor.
Dermatita eritematoas\u0103 \u015fi hiperpigmentarea este asociat\u0103 cu tratamentul cu bleomicin\u0103 (20% -30% din pacien\u021bi), urmat\u0103 de dermatita\u201eAddison-like, sindromul m\u00e2n\u0103- picior, cunoscut \u0219i sub denumirea de eritrodisestezie palmoplantar\u0103, poate apare dup\u0103 tratamente cu agen\u021bi precum capecitabin\u0103, doxorubicin\u0103, cibarabin\u0103, 5-Fluorouracil. Toxicit\u0103\u0163ile dermatologice sunt rareori fatale, dar pot determina o morbiditate semnificativ\u0103, desfigurare cosmetic\u0103 \u0219i suferin\u021b\u0103 psihologic\u0103.
Inhibitori de tirozin\u0103 kinaz\u0103 – TKI). cetuximab, panitumumab, gefitinib, erlotinib, lapatinib); agen\u021bi antiangiogeni, inhibitori ai receptorului factorului de cre\u0219tere endotelial vascular – VEGFRi (de exemplu, bevacizumab, sorafenib); inhibitori ai c\u0103ii proteice activate cu mitogen (MAPK), cum ar fi RAF (de exemplu vemurafenib, dabrafenib), MEKi (de exemplu, cobimetinib, trametinib); inhibitori mTOR (de ex. everolimus); inhibitori de multikinaza (de exemplu, vandetanib, pazopanib, sunitinib) \u0219i inhibitori ai c\u0103ii arici (vismodegib) sunt exemple de terapii moleculare \u0163intite.
Terapiile moleculare \u0163intite pot provoca, de asemenea, modific\u0103ri pigmentare, cum ar fi o pigmentare galben\u0103 la pacien\u021bii trata\u021bi cu sunitinib (inhibitor VEGFR), hipopigmentarea (difuz\u0103 sau localizat\u0103) asociat\u0103 cu tratamentul cu imatinib. Inhibitorii EGFR sunt frecvent asocia\u0163i cu toxicitatea frecvent\u0103 a unghiilor ( 17,2% dintre pacien\u021bii afla\u021bi \u00eentr-o meta-analiz\u0103). Fisurile periunghiale, paronychia \u0219i leziunile de tip granulom piogen \u00eencep s\u0103 se dezvolte la dou\u0103 sau mai multe luni dup\u0103 ini\u021bierea terapiei.
Erup\u021bia papulopustular\u0103: cunoscut\u0103 \u0219i sub denumirea de \u201eerup\u021bie cutanat\u0103 acneic\u0103\u201d sau \u201efoliculit\u0103\u201d, aceasta este cea mai frecvent\u0103 toxicitate dermatologic\u0103 dup\u0103 tratamentul cu inhibitori EGFR (cetuximab)i. Alte caracteristici care sunt prezente, mai ales ulterior tratamentului, sunt, fisurile periunguale \u0219i granuloamele, xeroza, pruritul \u0219i alterarea p\u0103rului precumi trichomegalie, hipertricoz\u0103 \u0219i alopecie ne-cicatricial\u0103
Imunoterapia utilizeaz\u0103 activarea sistemului imun pentru a lupta contra cancerului! Recent, imunoterapia a devenit o nou\u0103 alternativ\u0103 terapeutic\u0103 pentru pacien\u0163i cu cancer. Terapiile cu anticorpii monoclonali tip inhibitorii checkpoint precum: ipilimumab, nivolumab, pembrolizumab, atezolizumab, durvolumab \u015fi al\u0163ii au devenit uzuale \u00een tratamentul unui num\u0103r din ce \u00een ce mai mare de cancere. Unul dintre cele mai frecvente efecte secundare ale imunoterapiei este toxicitatea cutanat\u0103. Aceasta este cea mai frecvent\u0103 \u015fi apare \u015fi cel mai precoce la debutul tratamentului (rash \u015fi prurit dup\u0103 prima administrare). Pacien\u021bii pot prezenta obi\u0219nuit erup\u021bie cutanat\u0103 maculo-papular\u0103, care seam\u0103n\u0103 deseori cu o reac\u021bie medicamentoas\u0103 ori cu prurit semnificativ. Pruritul poate apare si f\u0103r\u0103 leziuni cutanate vizibile. Cele mai frecvente efecte cutanate apar la pacien\u021bii trata\u021bi cu inhibitori ai CTLA4 (ipilimumab 40%-60%) \u0219i anti PD-1 (nivolumab 25%) \u0219i PDL-1 (pembrolizumab, atezolizumab) se dezvolt\u0103 de obicei la \u00eenceputul tratamenului. Cele mai frecvente afect\u0103ri cutanate sunt: erup\u021biile cutanate, pruritul \u0219i vitiligo. Vitiligo apare mai frecvent la pacien\u021bii trata\u021bi pentru melanom. Efecte adverse mai rare includ alopecia areata, stomatita, xeroza cutanat\u0103, fotosensibilitatea, exacerbarea psoriazisului, reac\u021bii cutanate psoriziforme sau lichenioide. Din punct de vedere histologic reac\u021biile cutanate pot fi clasificate \u00een: tulbur\u0103ri cutanate inflamatorii, leziuni buloase, keratozice \u015fi melanice.
Reac\u021bii lichenoide: acele erup\u021bii se pot dezvolta at\u00e2t pe piele, c\u00e2t \u0219i \/ sau pe mucoase (pe cale oral\u0103 \u0219i genital\u0103). Implicarea oral\u0103 poate include, de asemenea, xerostomia \u0219i schimbarea gustului;psoriazis \u0219i rozacee: ace\u0219ti agen\u021bi ar putea induce exacerbarea sau noua apari\u021bie a psoriazisului, boli autoimune de tipu pemfigoid buloase. Imunoterapia a fost legat\u0103 de leziuni asem\u0103n\u0103toare cu vitiligo, \u00een principal, dar nu numai la pacien\u021bii trata\u021bi cu
Evenimentele adverse dermatologice sunt una dintre cele mai frecvente toxicit\u0103\u021bi observate pentru tratamentele \u00eempotriva cancerului. Chiar dac\u0103 apar rar ca manifest\u0103ri care nu pun via\u021ba pacientului \u00een pericol, acestea pot conduce la reducerea dozei sau chiar la \u00eentreruperea terapiei oncologice, care interfereaz\u0103 cu rezultatul bolii ca \u015fi un impact mare \u00een calitatea vie\u021bii pacientului. Diagnosticul \u015fi tratamentul acestor efecte secundare ofer\u0103 dermatologilor un rol important \u00een echipa multidisciplinar\u0103, fundamental\u0103 pentru cea mai bun\u0103 \u00eengrijire \u00een sprijinul pacien\u021bilor cu cancer.<\/p>\n
Dermatological sides effects on systemic therapies in cancer patients<\/span>
Author: Lucian Miron<\/span><\/p>\nIn the last decades, oncological treatments have undergone an important development through the emergence of new agents. Among the most common side effects of oncology therapies are skin changes called dermatological toxicities.
Conventional cytotoxic chemotherapy continues to play an important role in cancer treatment. The most common post-chemotherapy skin adverse events are: hyperpigmentation, hand-foot syndrome, radiation use, hypersensitivity, extravasation lesions and nail dystrophies.
Erythematous dermatitis and hyperpigmentation are associated with bleomycin treatment (20% -30% of patients), followed by “Addison-like dermatitis, known as palmoplantar erythrodysesthesia, which may occur after treatment with agents such as capecitabine, doxorubicin, cibarabine, 5-Fluorouracil. Dermatological toxicities are rarely fatal, but they can cause significant morbidity, cosmetic disfigurement and psychological distress.
Tyrosine kinase inhibitors (TKI). cetuximab, panitumumab, gefitinib, erlotinib, lapatinib), antiangiogenic agents, vascular endothelial growth factor receptor inhibitors – VEGFRi (eg, bevacizumab, sorafenib), mitogen-activated protein (MAPK) pathway inhibitors, such as RAF (eg, vemurafenib, dabrafenib), MEKi (eg, cobimetinib, trametinib); mTOR inhibitors (eg everolimus); multikinase inhibitors (eg, vandetanib, pazopanib, sunitinib) and hedgehog inhibitors (vismodegib) are examples of targeted molecular therapies.
Targeted molecular therapies may also cause pigmentation changes, such as yellow pigmentation in sunitinib (VEGFR inhibitor) treated patients, hypopigmentation (diffuse or localized) associated with imatinib treatment. EGFR inhibitors are frequently associated with frequent nail toxicity (17.2% of patients in a meta-analysis). Perioral fissures, paronychia and pyogenic granuloma lesions begin to develop two or more months after initiation of therapy.
.Pululopustular rash: also known as “acne rash” or “folliculitis”, this is the most common dermatological toxicity after treatment with EGFR inhibitors (cetuximab). Other features that are present, especially after the treatment, are, periungual cracks and granulomas, xerosis, pruritus and altered prichomegaly hair, hypertricosis and non-scarring alopecia.
Immunotherapy uses the activation of the immune system to fight cancer! Recently, immunotherapy has become a new therapeutic alternative for cancer patients. Monoclonal antibody therapies such as checkpoint inhibitors such as: ipilimumab, nivolumab, pembrolizumab, atezolizumab, durvolumab and others have become commonplace in the treatment of an increasing number of cancers. One of the most common side effects of immunotherapy is skin toxicity. This is the most common and appears even the earliest at the beginning of treatment (rash and pruritus after first administration). Patients may have a common macular-papular rash, which often resembles a drug reaction or significant itching. Ihting can also occur without visible skin lesions. The most common skin effects occur in patients treated with CTLA4 inhibitors (ipilimumab 40% -60%) and anti PD-1 (nivolumab 25%) and PDL-1 (pembrolizumab, atezolizumab) usually develops at the beginning of treatment. The most common skin conditions are: rash, itching and vitiligo. Vitiligo is more common in patients treated for melanoma. Rare side effects include alopecia areata, stomatitis, dermal kerosis, photosensitivity, exacerbation of psoriasis, psoriziform or lichenioid skin reactions. From the histological point of view, the skin reactions can be classified into: inflammatory skin disorders, bullous, keratotic and melanic lesions.
Lichenoid reactions: those rashes can develop on the skin and \/ or mucous membranes (orally and genitally). Oral involvement may also include xerostomia and taste change; psoriasis and rosacea: these agents may induce exacerbation or re-emergence of psoriasis, pemphigoid-type autoimmune diseases. Immunotherapy has been linked to vitiligo-like lesions, mainly, but not only to patients treated with
Dermatological adverse events are one of the most common toxicities observed for cancer treatments. Although they rarely occur as manifestations that do not endanger the patient’s life, they can lead to dose reduction or even discontinuation of oncological therapy, which interferes with the outcome of the disease.<\/p>\n
Scurt CV<\/span><\/p>\n<\/pabsolvent> Specializat la Institutul Oncologic \u201eAl Trestioreanu\u201d Bucure\u015fti \u015fi, ulterior cu stagii \u00een centre oncologice din Fran\u0163a si Italia. \u015ei-a sus\u0163ine teza de doctorat \u00een domeniul chimioterapiei citotoxice \u00een cancerele bronho-pulmonare non \u2013microcelulare, autor a numeroase articole \u015fi mai multe c\u0103r\u0163i de oncologie dintre care trei tratate de oncologie general\u0103 \u015fi de organ. Este specializat \u00een tratamentele sistemice actuale ale cancerelor: bronho-pulmonare, mamare, colo-rectale, genitale feminine, masculine, sarcoame \u015fi altele de interes (ex.Nutritia \u00een cancer). Pred\u0103 cursuri de oncologie la studen\u0163ii la medicin\u0103 UMF \u201e Grigore T. Popa\u201d Ia\u015fi \u015fi este responsabil de preg\u0103tirea medicilor reziden\u0163i \u00een specialitatea de Oncologie Medical\u0103 la IRO Ia\u015fi. Investigator principal in mai multe studii clinice interna\u0163ionale privind cancerele: mamare, bronho-pulmonare, heatocarcinom, colo-rectale, \u015fi cercetare a mai multe medica\u0163ii oncologice simptomatice. Participant la numeroase manifest\u0103rii oncologice regionale, na\u0163ionale \u015fi interna\u0163ionale este pre\u015fedintele manifest\u0103rii na\u0163ionale \u201dConferin\u0163ele Institutului Regional de Oncologie Ia\u015fi\u201d (CONFER), edi\u0163iile 2012-2020, organizatorul \u201e\u015ecolilor de Var\u0103\u201d IRO Iasi (edi\u0163iile 2014-2020), vicepresedintele Societatii Nationale de Oncologie Medicala din Romania (SNOMR) \u015fi membru a mai multe societ\u0103\u0163i de cancer interna\u0163ionale : ESMO, ASCO, IASCL \u015fi altele.<\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.22″ background_color=”rgba(117,194,33,0.23)” background_image=”https:\/\/pdi.ro\/2020\/wp-content\/uploads\/2020\/02\/back_justflowers_overlay1.png” background_blend=”luminosity” custom_padding=”54px|0px|0|0px|false|false” top_divider_style=”waves2″ top_divider_color=”#ffffff” top_divider_height=”155px” top_divider_height_tablet=”” top_divider_height_phone=”97px” top_divider_height_last_edited=”on|desktop” bottom_divider_style=”waves2″ bottom_divider_color=”#75c221″ bottom_divider_flip=”vertical” bottom_divider_height_tablet=”” bottom_divider_height_phone=”59px” bottom_divider_height_last_edited=”on|desktop”][et_pb_row column_structure=”3_5,2_5″ _builder_version=”3.25″ custom_padding=”61px|0px|69px|0px|false|false”][et_pb_column type=”3_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.0.11″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” text_line_height=”1.2em” header_font=”||||||||” background_layout=”dark” text_font_size_tablet=”” text_font_size_phone=”” text_font_size_last_edited=”on|desktop”]<\/p>\n
Contacteaz\u0103 operatorul PDI 2020<\/p>\n
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Operatorul PDI 2020<\/p>\n
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Tel.: 0332.40.88.00-05<\/span>
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Parteneri Media<\/p>\n
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Prof. Univ. Dr. Lucian Miron Universitatea de Medicin\u0103 \u0219i Farmacie “Grigore T. Popa\u201d Ia\u015fi Institutul Regional de Oncologie Ia\u015fiEfecte secundare dermatologice ale terapiilor sistemice la pacien\u021bii oncologici Autor: Lucian Miron \u00cen ultimele decenii, tratamentele oncologice au cunoscut o dezvoltare important\u0103 prin apari\u0163ia de noi agen\u021bi. Printre cele mai frecvente efecte secundare ale terapiilor oncologice sunt […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-8071","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8071","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/comments?post=8071"}],"version-history":[{"count":7,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8071\/revisions"}],"predecessor-version":[{"id":8667,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8071\/revisions\/8667"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/media?parent=8071"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Prof. Univ. Dr. Lucian Miron <\/span><\/strong>
\nUniversitatea de Medicin\u0103 \u0219i Farmacie “Grigore T. Popa\u201d Ia\u015fi
\nInstitutul Regional de Oncologie Ia\u015fi<\/span><\/strong><\/h4>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.25″][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.4.8″ hover_enabled=”0″]<\/p>\n
Efecte secundare dermatologice ale terapiilor sistemice la pacien\u021bii oncologici<\/span>
Autor: Lucian Miron<\/span><\/p>\n\u00cen ultimele decenii, tratamentele oncologice au cunoscut o dezvoltare important\u0103 prin apari\u0163ia de noi agen\u021bi. Printre cele mai frecvente efecte secundare ale terapiilor oncologice sunt \u015fi modific\u0103rile cutanate denumite toxicit\u0103\u021bi dermatologice.
Chimioterapia citotoxic\u0103 conven\u021bional\u0103 continu\u0103 s\u0103 joace un rol important \u00een tratamentul cancerului. Cele mai frecvente manifest\u0103ri adverse cutanate post-chimioterapie sunt: hiperpigmentarea, sindromul m\u00e2n\u0103-picior, recurgerea la radia\u021bii, hipersensibilitate, leziuni de extravazare \u0219i distrofii ale unghiilor.
Dermatita eritematoas\u0103 \u015fi hiperpigmentarea este asociat\u0103 cu tratamentul cu bleomicin\u0103 (20% -30% din pacien\u021bi), urmat\u0103 de dermatita\u201eAddison-like, sindromul m\u00e2n\u0103- picior, cunoscut \u0219i sub denumirea de eritrodisestezie palmoplantar\u0103, poate apare dup\u0103 tratamente cu agen\u021bi precum capecitabin\u0103, doxorubicin\u0103, cibarabin\u0103, 5-Fluorouracil. Toxicit\u0103\u0163ile dermatologice sunt rareori fatale, dar pot determina o morbiditate semnificativ\u0103, desfigurare cosmetic\u0103 \u0219i suferin\u021b\u0103 psihologic\u0103.
Inhibitori de tirozin\u0103 kinaz\u0103 – TKI). cetuximab, panitumumab, gefitinib, erlotinib, lapatinib); agen\u021bi antiangiogeni, inhibitori ai receptorului factorului de cre\u0219tere endotelial vascular – VEGFRi (de exemplu, bevacizumab, sorafenib); inhibitori ai c\u0103ii proteice activate cu mitogen (MAPK), cum ar fi RAF (de exemplu vemurafenib, dabrafenib), MEKi (de exemplu, cobimetinib, trametinib); inhibitori mTOR (de ex. everolimus); inhibitori de multikinaza (de exemplu, vandetanib, pazopanib, sunitinib) \u0219i inhibitori ai c\u0103ii arici (vismodegib) sunt exemple de terapii moleculare \u0163intite.
Terapiile moleculare \u0163intite pot provoca, de asemenea, modific\u0103ri pigmentare, cum ar fi o pigmentare galben\u0103 la pacien\u021bii trata\u021bi cu sunitinib (inhibitor VEGFR), hipopigmentarea (difuz\u0103 sau localizat\u0103) asociat\u0103 cu tratamentul cu imatinib. Inhibitorii EGFR sunt frecvent asocia\u0163i cu toxicitatea frecvent\u0103 a unghiilor ( 17,2% dintre pacien\u021bii afla\u021bi \u00eentr-o meta-analiz\u0103). Fisurile periunghiale, paronychia \u0219i leziunile de tip granulom piogen \u00eencep s\u0103 se dezvolte la dou\u0103 sau mai multe luni dup\u0103 ini\u021bierea terapiei.
Erup\u021bia papulopustular\u0103: cunoscut\u0103 \u0219i sub denumirea de \u201eerup\u021bie cutanat\u0103 acneic\u0103\u201d sau \u201efoliculit\u0103\u201d, aceasta este cea mai frecvent\u0103 toxicitate dermatologic\u0103 dup\u0103 tratamentul cu inhibitori EGFR (cetuximab)i. Alte caracteristici care sunt prezente, mai ales ulterior tratamentului, sunt, fisurile periunguale \u0219i granuloamele, xeroza, pruritul \u0219i alterarea p\u0103rului precumi trichomegalie, hipertricoz\u0103 \u0219i alopecie ne-cicatricial\u0103
Imunoterapia utilizeaz\u0103 activarea sistemului imun pentru a lupta contra cancerului! Recent, imunoterapia a devenit o nou\u0103 alternativ\u0103 terapeutic\u0103 pentru pacien\u0163i cu cancer. Terapiile cu anticorpii monoclonali tip inhibitorii checkpoint precum: ipilimumab, nivolumab, pembrolizumab, atezolizumab, durvolumab \u015fi al\u0163ii au devenit uzuale \u00een tratamentul unui num\u0103r din ce \u00een ce mai mare de cancere. Unul dintre cele mai frecvente efecte secundare ale imunoterapiei este toxicitatea cutanat\u0103. Aceasta este cea mai frecvent\u0103 \u015fi apare \u015fi cel mai precoce la debutul tratamentului (rash \u015fi prurit dup\u0103 prima administrare). Pacien\u021bii pot prezenta obi\u0219nuit erup\u021bie cutanat\u0103 maculo-papular\u0103, care seam\u0103n\u0103 deseori cu o reac\u021bie medicamentoas\u0103 ori cu prurit semnificativ. Pruritul poate apare si f\u0103r\u0103 leziuni cutanate vizibile. Cele mai frecvente efecte cutanate apar la pacien\u021bii trata\u021bi cu inhibitori ai CTLA4 (ipilimumab 40%-60%) \u0219i anti PD-1 (nivolumab 25%) \u0219i PDL-1 (pembrolizumab, atezolizumab) se dezvolt\u0103 de obicei la \u00eenceputul tratamenului. Cele mai frecvente afect\u0103ri cutanate sunt: erup\u021biile cutanate, pruritul \u0219i vitiligo. Vitiligo apare mai frecvent la pacien\u021bii trata\u021bi pentru melanom. Efecte adverse mai rare includ alopecia areata, stomatita, xeroza cutanat\u0103, fotosensibilitatea, exacerbarea psoriazisului, reac\u021bii cutanate psoriziforme sau lichenioide. Din punct de vedere histologic reac\u021biile cutanate pot fi clasificate \u00een: tulbur\u0103ri cutanate inflamatorii, leziuni buloase, keratozice \u015fi melanice.
Reac\u021bii lichenoide: acele erup\u021bii se pot dezvolta at\u00e2t pe piele, c\u00e2t \u0219i \/ sau pe mucoase (pe cale oral\u0103 \u0219i genital\u0103). Implicarea oral\u0103 poate include, de asemenea, xerostomia \u0219i schimbarea gustului;psoriazis \u0219i rozacee: ace\u0219ti agen\u021bi ar putea induce exacerbarea sau noua apari\u021bie a psoriazisului, boli autoimune de tipu pemfigoid buloase. Imunoterapia a fost legat\u0103 de leziuni asem\u0103n\u0103toare cu vitiligo, \u00een principal, dar nu numai la pacien\u021bii trata\u021bi cu
Evenimentele adverse dermatologice sunt una dintre cele mai frecvente toxicit\u0103\u021bi observate pentru tratamentele \u00eempotriva cancerului. Chiar dac\u0103 apar rar ca manifest\u0103ri care nu pun via\u021ba pacientului \u00een pericol, acestea pot conduce la reducerea dozei sau chiar la \u00eentreruperea terapiei oncologice, care interfereaz\u0103 cu rezultatul bolii ca \u015fi un impact mare \u00een calitatea vie\u021bii pacientului. Diagnosticul \u015fi tratamentul acestor efecte secundare ofer\u0103 dermatologilor un rol important \u00een echipa multidisciplinar\u0103, fundamental\u0103 pentru cea mai bun\u0103 \u00eengrijire \u00een sprijinul pacien\u021bilor cu cancer.<\/p>\n
Dermatological sides effects on systemic therapies in cancer patients<\/span>
Author: Lucian Miron<\/span><\/p>\nIn the last decades, oncological treatments have undergone an important development through the emergence of new agents. Among the most common side effects of oncology therapies are skin changes called dermatological toxicities.
Conventional cytotoxic chemotherapy continues to play an important role in cancer treatment. The most common post-chemotherapy skin adverse events are: hyperpigmentation, hand-foot syndrome, radiation use, hypersensitivity, extravasation lesions and nail dystrophies.
Erythematous dermatitis and hyperpigmentation are associated with bleomycin treatment (20% -30% of patients), followed by “Addison-like dermatitis, known as palmoplantar erythrodysesthesia, which may occur after treatment with agents such as capecitabine, doxorubicin, cibarabine, 5-Fluorouracil. Dermatological toxicities are rarely fatal, but they can cause significant morbidity, cosmetic disfigurement and psychological distress.
Tyrosine kinase inhibitors (TKI). cetuximab, panitumumab, gefitinib, erlotinib, lapatinib), antiangiogenic agents, vascular endothelial growth factor receptor inhibitors – VEGFRi (eg, bevacizumab, sorafenib), mitogen-activated protein (MAPK) pathway inhibitors, such as RAF (eg, vemurafenib, dabrafenib), MEKi (eg, cobimetinib, trametinib); mTOR inhibitors (eg everolimus); multikinase inhibitors (eg, vandetanib, pazopanib, sunitinib) and hedgehog inhibitors (vismodegib) are examples of targeted molecular therapies.
Targeted molecular therapies may also cause pigmentation changes, such as yellow pigmentation in sunitinib (VEGFR inhibitor) treated patients, hypopigmentation (diffuse or localized) associated with imatinib treatment. EGFR inhibitors are frequently associated with frequent nail toxicity (17.2% of patients in a meta-analysis). Perioral fissures, paronychia and pyogenic granuloma lesions begin to develop two or more months after initiation of therapy.
.Pululopustular rash: also known as “acne rash” or “folliculitis”, this is the most common dermatological toxicity after treatment with EGFR inhibitors (cetuximab). Other features that are present, especially after the treatment, are, periungual cracks and granulomas, xerosis, pruritus and altered prichomegaly hair, hypertricosis and non-scarring alopecia.
Immunotherapy uses the activation of the immune system to fight cancer! Recently, immunotherapy has become a new therapeutic alternative for cancer patients. Monoclonal antibody therapies such as checkpoint inhibitors such as: ipilimumab, nivolumab, pembrolizumab, atezolizumab, durvolumab and others have become commonplace in the treatment of an increasing number of cancers. One of the most common side effects of immunotherapy is skin toxicity. This is the most common and appears even the earliest at the beginning of treatment (rash and pruritus after first administration). Patients may have a common macular-papular rash, which often resembles a drug reaction or significant itching. Ihting can also occur without visible skin lesions. The most common skin effects occur in patients treated with CTLA4 inhibitors (ipilimumab 40% -60%) and anti PD-1 (nivolumab 25%) and PDL-1 (pembrolizumab, atezolizumab) usually develops at the beginning of treatment. The most common skin conditions are: rash, itching and vitiligo. Vitiligo is more common in patients treated for melanoma. Rare side effects include alopecia areata, stomatitis, dermal kerosis, photosensitivity, exacerbation of psoriasis, psoriziform or lichenioid skin reactions. From the histological point of view, the skin reactions can be classified into: inflammatory skin disorders, bullous, keratotic and melanic lesions.
Lichenoid reactions: those rashes can develop on the skin and \/ or mucous membranes (orally and genitally). Oral involvement may also include xerostomia and taste change; psoriasis and rosacea: these agents may induce exacerbation or re-emergence of psoriasis, pemphigoid-type autoimmune diseases. Immunotherapy has been linked to vitiligo-like lesions, mainly, but not only to patients treated with
Dermatological adverse events are one of the most common toxicities observed for cancer treatments. Although they rarely occur as manifestations that do not endanger the patient’s life, they can lead to dose reduction or even discontinuation of oncological therapy, which interferes with the outcome of the disease.<\/p>\n
Scurt CV<\/span><\/p>\n<\/pabsolvent> Specializat la Institutul Oncologic \u201eAl Trestioreanu\u201d Bucure\u015fti \u015fi, ulterior cu stagii \u00een centre oncologice din Fran\u0163a si Italia. \u015ei-a sus\u0163ine teza de doctorat \u00een domeniul chimioterapiei citotoxice \u00een cancerele bronho-pulmonare non \u2013microcelulare, autor a numeroase articole \u015fi mai multe c\u0103r\u0163i de oncologie dintre care trei tratate de oncologie general\u0103 \u015fi de organ. Este specializat \u00een tratamentele sistemice actuale ale cancerelor: bronho-pulmonare, mamare, colo-rectale, genitale feminine, masculine, sarcoame \u015fi altele de interes (ex.Nutritia \u00een cancer). Pred\u0103 cursuri de oncologie la studen\u0163ii la medicin\u0103 UMF \u201e Grigore T. Popa\u201d Ia\u015fi \u015fi este responsabil de preg\u0103tirea medicilor reziden\u0163i \u00een specialitatea de Oncologie Medical\u0103 la IRO Ia\u015fi. Investigator principal in mai multe studii clinice interna\u0163ionale privind cancerele: mamare, bronho-pulmonare, heatocarcinom, colo-rectale, \u015fi cercetare a mai multe medica\u0163ii oncologice simptomatice. Participant la numeroase manifest\u0103rii oncologice regionale, na\u0163ionale \u015fi interna\u0163ionale este pre\u015fedintele manifest\u0103rii na\u0163ionale \u201dConferin\u0163ele Institutului Regional de Oncologie Ia\u015fi\u201d (CONFER), edi\u0163iile 2012-2020, organizatorul \u201e\u015ecolilor de Var\u0103\u201d IRO Iasi (edi\u0163iile 2014-2020), vicepresedintele Societatii Nationale de Oncologie Medicala din Romania (SNOMR) \u015fi membru a mai multe societ\u0103\u0163i de cancer interna\u0163ionale : ESMO, ASCO, IASCL \u015fi altele.<\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.22″ background_color=”rgba(117,194,33,0.23)” background_image=”https:\/\/pdi.ro\/2020\/wp-content\/uploads\/2020\/02\/back_justflowers_overlay1.png” background_blend=”luminosity” custom_padding=”54px|0px|0|0px|false|false” top_divider_style=”waves2″ top_divider_color=”#ffffff” top_divider_height=”155px” top_divider_height_tablet=”” top_divider_height_phone=”97px” top_divider_height_last_edited=”on|desktop” bottom_divider_style=”waves2″ bottom_divider_color=”#75c221″ bottom_divider_flip=”vertical” bottom_divider_height_tablet=”” bottom_divider_height_phone=”59px” bottom_divider_height_last_edited=”on|desktop”][et_pb_row column_structure=”3_5,2_5″ _builder_version=”3.25″ custom_padding=”61px|0px|69px|0px|false|false”][et_pb_column type=”3_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.0.11″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” text_line_height=”1.2em” header_font=”||||||||” background_layout=”dark” text_font_size_tablet=”” text_font_size_phone=”” text_font_size_last_edited=”on|desktop”]<\/p>\n
Contacteaz\u0103 operatorul PDI 2020<\/p>\n
[\/et_pb_text][et_pb_contact_form email=”contact@primaderma.ro\/2019″ submit_button_text=”Trimite mesajul” _builder_version=”3.19.4″ title_font=”||||||||”][et_pb_contact_field field_id=”Name” field_title=”Nume” _builder_version=”3.18.9″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Email” field_title=”Adresa de e-mail” field_type=”email” _builder_version=”3.19.4″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Message” field_title=”Mesajul dvs.” field_type=”text” fullwidth_field=”on” _builder_version=”3.18.9″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][\/et_pb_contact_form][\/et_pb_column][et_pb_column type=”2_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.0.11″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” header_font=”||||||||” background_layout=”dark”]<\/p>\n
Operatorul PDI 2020<\/p>\n
[\/et_pb_text][et_pb_text _builder_version=”4.0.11″ text_font=”||||||||”]<\/p>\n
<\/span><\/p>\n<\/span><\/p>\n<\/span><\/p>\nAdresa: Str. A. Panu nr. 13, Iasi<\/span>
Tel.: 0332.40.88.00-05<\/span>
E-mail: inscrieri@primaderma.ro<\/a>
<\/span>Website:\u00a0<\/span>www.eventernet.ro<\/a><\/p>\n[\/et_pb_text][et_pb_text disabled_on=”off|off|off” _builder_version=”4.0.11″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” header_font=”||||||||” background_layout=”dark” locked=”off”]<\/p>\n
Parteneri Media<\/p>\n
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Prof. Univ. Dr. Lucian Miron Universitatea de Medicin\u0103 \u0219i Farmacie “Grigore T. Popa\u201d Ia\u015fi Institutul Regional de Oncologie Ia\u015fiEfecte secundare dermatologice ale terapiilor sistemice la pacien\u021bii oncologici Autor: Lucian Miron \u00cen ultimele decenii, tratamentele oncologice au cunoscut o dezvoltare important\u0103 prin apari\u0163ia de noi agen\u021bi. Printre cele mai frecvente efecte secundare ale terapiilor oncologice sunt […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-8071","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8071","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/comments?post=8071"}],"version-history":[{"count":7,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8071\/revisions"}],"predecessor-version":[{"id":8667,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8071\/revisions\/8667"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/media?parent=8071"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Autor: Lucian Miron<\/span><\/p>\n
\u00cen ultimele decenii, tratamentele oncologice au cunoscut o dezvoltare important\u0103 prin apari\u0163ia de noi agen\u021bi. Printre cele mai frecvente efecte secundare ale terapiilor oncologice sunt \u015fi modific\u0103rile cutanate denumite toxicit\u0103\u021bi dermatologice.
Chimioterapia citotoxic\u0103 conven\u021bional\u0103 continu\u0103 s\u0103 joace un rol important \u00een tratamentul cancerului. Cele mai frecvente manifest\u0103ri adverse cutanate post-chimioterapie sunt: hiperpigmentarea, sindromul m\u00e2n\u0103-picior, recurgerea la radia\u021bii, hipersensibilitate, leziuni de extravazare \u0219i distrofii ale unghiilor.
Dermatita eritematoas\u0103 \u015fi hiperpigmentarea este asociat\u0103 cu tratamentul cu bleomicin\u0103 (20% -30% din pacien\u021bi), urmat\u0103 de dermatita\u201eAddison-like, sindromul m\u00e2n\u0103- picior, cunoscut \u0219i sub denumirea de eritrodisestezie palmoplantar\u0103, poate apare dup\u0103 tratamente cu agen\u021bi precum capecitabin\u0103, doxorubicin\u0103, cibarabin\u0103, 5-Fluorouracil. Toxicit\u0103\u0163ile dermatologice sunt rareori fatale, dar pot determina o morbiditate semnificativ\u0103, desfigurare cosmetic\u0103 \u0219i suferin\u021b\u0103 psihologic\u0103.
Inhibitori de tirozin\u0103 kinaz\u0103 – TKI). cetuximab, panitumumab, gefitinib, erlotinib, lapatinib); agen\u021bi antiangiogeni, inhibitori ai receptorului factorului de cre\u0219tere endotelial vascular – VEGFRi (de exemplu, bevacizumab, sorafenib); inhibitori ai c\u0103ii proteice activate cu mitogen (MAPK), cum ar fi RAF (de exemplu vemurafenib, dabrafenib), MEKi (de exemplu, cobimetinib, trametinib); inhibitori mTOR (de ex. everolimus); inhibitori de multikinaza (de exemplu, vandetanib, pazopanib, sunitinib) \u0219i inhibitori ai c\u0103ii arici (vismodegib) sunt exemple de terapii moleculare \u0163intite.
Terapiile moleculare \u0163intite pot provoca, de asemenea, modific\u0103ri pigmentare, cum ar fi o pigmentare galben\u0103 la pacien\u021bii trata\u021bi cu sunitinib (inhibitor VEGFR), hipopigmentarea (difuz\u0103 sau localizat\u0103) asociat\u0103 cu tratamentul cu imatinib. Inhibitorii EGFR sunt frecvent asocia\u0163i cu toxicitatea frecvent\u0103 a unghiilor ( 17,2% dintre pacien\u021bii afla\u021bi \u00eentr-o meta-analiz\u0103). Fisurile periunghiale, paronychia \u0219i leziunile de tip granulom piogen \u00eencep s\u0103 se dezvolte la dou\u0103 sau mai multe luni dup\u0103 ini\u021bierea terapiei.
Erup\u021bia papulopustular\u0103: cunoscut\u0103 \u0219i sub denumirea de \u201eerup\u021bie cutanat\u0103 acneic\u0103\u201d sau \u201efoliculit\u0103\u201d, aceasta este cea mai frecvent\u0103 toxicitate dermatologic\u0103 dup\u0103 tratamentul cu inhibitori EGFR (cetuximab)i. Alte caracteristici care sunt prezente, mai ales ulterior tratamentului, sunt, fisurile periunguale \u0219i granuloamele, xeroza, pruritul \u0219i alterarea p\u0103rului precumi trichomegalie, hipertricoz\u0103 \u0219i alopecie ne-cicatricial\u0103
Imunoterapia utilizeaz\u0103 activarea sistemului imun pentru a lupta contra cancerului! Recent, imunoterapia a devenit o nou\u0103 alternativ\u0103 terapeutic\u0103 pentru pacien\u0163i cu cancer. Terapiile cu anticorpii monoclonali tip inhibitorii checkpoint precum: ipilimumab, nivolumab, pembrolizumab, atezolizumab, durvolumab \u015fi al\u0163ii au devenit uzuale \u00een tratamentul unui num\u0103r din ce \u00een ce mai mare de cancere. Unul dintre cele mai frecvente efecte secundare ale imunoterapiei este toxicitatea cutanat\u0103. Aceasta este cea mai frecvent\u0103 \u015fi apare \u015fi cel mai precoce la debutul tratamentului (rash \u015fi prurit dup\u0103 prima administrare). Pacien\u021bii pot prezenta obi\u0219nuit erup\u021bie cutanat\u0103 maculo-papular\u0103, care seam\u0103n\u0103 deseori cu o reac\u021bie medicamentoas\u0103 ori cu prurit semnificativ. Pruritul poate apare si f\u0103r\u0103 leziuni cutanate vizibile. Cele mai frecvente efecte cutanate apar la pacien\u021bii trata\u021bi cu inhibitori ai CTLA4 (ipilimumab 40%-60%) \u0219i anti PD-1 (nivolumab 25%) \u0219i PDL-1 (pembrolizumab, atezolizumab) se dezvolt\u0103 de obicei la \u00eenceputul tratamenului. Cele mai frecvente afect\u0103ri cutanate sunt: erup\u021biile cutanate, pruritul \u0219i vitiligo. Vitiligo apare mai frecvent la pacien\u021bii trata\u021bi pentru melanom. Efecte adverse mai rare includ alopecia areata, stomatita, xeroza cutanat\u0103, fotosensibilitatea, exacerbarea psoriazisului, reac\u021bii cutanate psoriziforme sau lichenioide. Din punct de vedere histologic reac\u021biile cutanate pot fi clasificate \u00een: tulbur\u0103ri cutanate inflamatorii, leziuni buloase, keratozice \u015fi melanice.
Reac\u021bii lichenoide: acele erup\u021bii se pot dezvolta at\u00e2t pe piele, c\u00e2t \u0219i \/ sau pe mucoase (pe cale oral\u0103 \u0219i genital\u0103). Implicarea oral\u0103 poate include, de asemenea, xerostomia \u0219i schimbarea gustului;psoriazis \u0219i rozacee: ace\u0219ti agen\u021bi ar putea induce exacerbarea sau noua apari\u021bie a psoriazisului, boli autoimune de tipu pemfigoid buloase. Imunoterapia a fost legat\u0103 de leziuni asem\u0103n\u0103toare cu vitiligo, \u00een principal, dar nu numai la pacien\u021bii trata\u021bi cu
Evenimentele adverse dermatologice sunt una dintre cele mai frecvente toxicit\u0103\u021bi observate pentru tratamentele \u00eempotriva cancerului. Chiar dac\u0103 apar rar ca manifest\u0103ri care nu pun via\u021ba pacientului \u00een pericol, acestea pot conduce la reducerea dozei sau chiar la \u00eentreruperea terapiei oncologice, care interfereaz\u0103 cu rezultatul bolii ca \u015fi un impact mare \u00een calitatea vie\u021bii pacientului. Diagnosticul \u015fi tratamentul acestor efecte secundare ofer\u0103 dermatologilor un rol important \u00een echipa multidisciplinar\u0103, fundamental\u0103 pentru cea mai bun\u0103 \u00eengrijire \u00een sprijinul pacien\u021bilor cu cancer.<\/p>\n
Dermatological sides effects on systemic therapies in cancer patients<\/span> In the last decades, oncological treatments have undergone an important development through the emergence of new agents. Among the most common side effects of oncology therapies are skin changes called dermatological toxicities. 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Popa\u201d Ia\u015fi Institutul Regional de Oncologie Ia\u015fiEfecte secundare dermatologice ale terapiilor sistemice la pacien\u021bii oncologici Autor: Lucian Miron \u00cen ultimele decenii, tratamentele oncologice au cunoscut o dezvoltare important\u0103 prin apari\u0163ia de noi agen\u021bi. Printre cele mai frecvente efecte secundare ale terapiilor oncologice sunt […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-8071","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8071","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/comments?post=8071"}],"version-history":[{"count":7,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8071\/revisions"}],"predecessor-version":[{"id":8667,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/8071\/revisions\/8667"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/media?parent=8071"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Author: Lucian Miron<\/span><\/p>\n
Conventional cytotoxic chemotherapy continues to play an important role in cancer treatment. The most common post-chemotherapy skin adverse events are: hyperpigmentation, hand-foot syndrome, radiation use, hypersensitivity, extravasation lesions and nail dystrophies.
Erythematous dermatitis and hyperpigmentation are associated with bleomycin treatment (20% -30% of patients), followed by “Addison-like dermatitis, known as palmoplantar erythrodysesthesia, which may occur after treatment with agents such as capecitabine, doxorubicin, cibarabine, 5-Fluorouracil. Dermatological toxicities are rarely fatal, but they can cause significant morbidity, cosmetic disfigurement and psychological distress.
Tyrosine kinase inhibitors (TKI). cetuximab, panitumumab, gefitinib, erlotinib, lapatinib), antiangiogenic agents, vascular endothelial growth factor receptor inhibitors – VEGFRi (eg, bevacizumab, sorafenib), mitogen-activated protein (MAPK) pathway inhibitors, such as RAF (eg, vemurafenib, dabrafenib), MEKi (eg, cobimetinib, trametinib); mTOR inhibitors (eg everolimus); multikinase inhibitors (eg, vandetanib, pazopanib, sunitinib) and hedgehog inhibitors (vismodegib) are examples of targeted molecular therapies.
Targeted molecular therapies may also cause pigmentation changes, such as yellow pigmentation in sunitinib (VEGFR inhibitor) treated patients, hypopigmentation (diffuse or localized) associated with imatinib treatment. EGFR inhibitors are frequently associated with frequent nail toxicity (17.2% of patients in a meta-analysis). Perioral fissures, paronychia and pyogenic granuloma lesions begin to develop two or more months after initiation of therapy.
.Pululopustular rash: also known as “acne rash” or “folliculitis”, this is the most common dermatological toxicity after treatment with EGFR inhibitors (cetuximab). Other features that are present, especially after the treatment, are, periungual cracks and granulomas, xerosis, pruritus and altered prichomegaly hair, hypertricosis and non-scarring alopecia.
Immunotherapy uses the activation of the immune system to fight cancer! Recently, immunotherapy has become a new therapeutic alternative for cancer patients. Monoclonal antibody therapies such as checkpoint inhibitors such as: ipilimumab, nivolumab, pembrolizumab, atezolizumab, durvolumab and others have become commonplace in the treatment of an increasing number of cancers. One of the most common side effects of immunotherapy is skin toxicity. This is the most common and appears even the earliest at the beginning of treatment (rash and pruritus after first administration). Patients may have a common macular-papular rash, which often resembles a drug reaction or significant itching. Ihting can also occur without visible skin lesions. The most common skin effects occur in patients treated with CTLA4 inhibitors (ipilimumab 40% -60%) and anti PD-1 (nivolumab 25%) and PDL-1 (pembrolizumab, atezolizumab) usually develops at the beginning of treatment. The most common skin conditions are: rash, itching and vitiligo. Vitiligo is more common in patients treated for melanoma. Rare side effects include alopecia areata, stomatitis, dermal kerosis, photosensitivity, exacerbation of psoriasis, psoriziform or lichenioid skin reactions. From the histological point of view, the skin reactions can be classified into: inflammatory skin disorders, bullous, keratotic and melanic lesions.
Lichenoid reactions: those rashes can develop on the skin and \/ or mucous membranes (orally and genitally). Oral involvement may also include xerostomia and taste change; psoriasis and rosacea: these agents may induce exacerbation or re-emergence of psoriasis, pemphigoid-type autoimmune diseases. Immunotherapy has been linked to vitiligo-like lesions, mainly, but not only to patients treated with
Dermatological adverse events are one of the most common toxicities observed for cancer treatments. Although they rarely occur as manifestations that do not endanger the patient’s life, they can lead to dose reduction or even discontinuation of oncological therapy, which interferes with the outcome of the disease.<\/p>\n<\/span><\/p>\n
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