Radiation Recall Dermatitis With Concomitant Dabrafenib and Pazopanib Therapy | Dermatology | JAMA Dermatology | JAMA Network
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Observation
May 2016

Radiation Recall Dermatitis With Concomitant Dabrafenib and Pazopanib Therapy

Author Affiliations
  • 1Division of Medical Oncology, Department of Internal Medicine, Stanford University, Stanford, California
  • 2Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus
  • 3Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus
  • 4Division of Dermatology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus
JAMA Dermatol. 2016;152(5):587-589. doi:10.1001/jamadermatol.2015.5366

Radiation recall was first described in 1959 and is a tissue reaction that occurs in a previously irradiated area after administration usually of an antineoplastic or other class of agent.1 The incidence of radiation recall with targeted oncologic therapies is not well established. We report a case of radiation recall dermatitis occurring 3 days after initiation of combination therapy with dabrafenib and pazopanib.

A man in his 60s was treated for BRAF-mutated (p.G464V, non-V600E), metastatic, non–small-cell lung adenocarcinoma of the bone and thoracic lymph nodes. He had an intramedullary nail placement for a femoral bone metastasis and received whole-femur irradiation, 30 Gy, without complication (Figure, A). Eight weeks later, the patient started a phase 1 clinical trial of oral dabrafenib, 150 mg, twice a day (BRAF inhibitor) and oral pazopanib, 800 mg, once daily (multikinase inhibitor). The patient developed a burning sensation along with a well-demarcated eruption a few hours after the study drugs were administered on day 3 (Figure, B). Blood test findings, including white blood cell count, were within normal limits. Administration of study drugs was discontinued on day 4, and a skin biopsy revealed eccrine squamous syringometaplasia, epidermal dysmaturation, and radiation-associated changes. The patient began treatment with fluocinonide, 0.05%, cream and was not rechallenged with dabrafenib or pazopanib. He started to recover within 14 days and recovered fully, albeit with residual dyspigmentation, 4 months later.

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