Acute Generalized Exanthematous Pustulosis Induced by Sorafenib | Dermatology | JAMA Dermatology | JAMA Network
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Observation
June 2014

Acute Generalized Exanthematous Pustulosis Induced by Sorafenib

Author Affiliations
  • 1Department of Dermatology, School of Medicine, University Clinic of Navarra, Pamplona, Spain
  • 2Department of Pathology, School of Medicine, University Clinic of Navarra, Pamplona, Spain
JAMA Dermatol. 2014;150(6):664-666. doi:10.1001/jamadermatol.2013.6924

Sorafenib (Nexavar; Bayer HealthCare AG) is an oral multikinase inhibitor approved by the US Food and Drug Administration for the treatment of unresectable hepatocellular carcinoma and advanced renal cell carcinoma. It inhibits multiple tyrosine kinases, including C-RAF and B-RAF, vascular endothelial growth factor receptors, and platelet-derived growth factor receptor (PDGFR).

Acute generalized exanthematous pustulosis (AGEP) is a rare skin eruption associated principally with drugs. To our knowledge, only 1 report of sorafenib-induced acute localized exanthematous pustulosis (ALEP) has been published.1 Herein, we report the first case of AGEP induced by sorafenib.

A woman in her 50s presented with a history of multifocal hepatocarcinoma previously treated unsuccessfully with radiofrequency, arterial embolization, and selective hepatic radioembolization. After the appearance of lung metastases, treatment was begun with sorafenib (400 mg every 12 hours). Two weeks later, the patient developed hand-foot skin reaction (HSFR), so the treatment was suspended with resolution of the lesions. Treatment with the drug was reintroduced at half dose with good results, and full doses were then administered. Ten days later, the HSFR reappeared, and sorafenib treatment was suspended again. After 3 weeks, sorafenib treatment was restarted at half dose.

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