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November 21, 2018

Metastatic Calcinosis Cutis Associated With a Selective FGFR Inhibitor

Author Affiliations
  • 1Division of Dermatology, Department of Medicine, The Ohio State University, Columbus
  • 2Division of Medical Oncology, Department of Medicine, The Ohio State University, Columbus
  • 3Division of Dermatopathology, Department of Pathology, The Ohio State University, Columbus
JAMA Dermatol. Published online November 21, 2018. doi:10.1001/jamadermatol.2018.4070

Fibroblast growth factor receptor (FGFR) inhibitors are a new class of targeted antineoplastic therapy. They have been shown to affect phosphate homeostasis, and we present a case of metastatic calcinosis cutis associated with the initiation of FGFR inhibitor therapy.

A man in his 60s presented with well-circumscribed, indurated plaques over the bilateral axillae and inguinal folds (Figure 1). His medical history was significant for metastatic intrahepatic cholangiocarcinoma treated initially with cisplatin and gemcitabine. Shortly thereafter, he demonstrated progressive disease, and subsequent genomic profiling of his tumor revealed the missense mutation W290R in the FGFR2 gene. The patient was enrolled in a clinical trial evaluating the multikinase inhibitor ponatinib, a nonselective FGFR inhibitor. The patient received 7 cycles of ponatinib, but treatment was stopped owing to the occurrence of supraventricular tachycardia attributed to the medication. The patient was then enrolled in another clinical trial, and treatment with BGJ398 (infigratinib), a selective FGFR inhibitor, was initiated. At the time of his presentation, he had completed 3 months of infigratinib therapy.