Cancer Res Treat.  2016 Jan;48(1):162-170. 10.4143/crt.2015.017.

Severe Imatinib-Associated Skin Rash in Gastrointestinal Stromal Tumor Patients: Management and Clinical Implications

• Park SR
• Ryu MH
• Ryoo BY
• Beck MY
• Lee IS
• Choi MJ
• Lee MW
• Kang YK

• KMID: 2152272
• DOI: http://doi.org/10.4143/crt.2015.017

Abstract

PURPOSE
This study evaluated the incidence of imatinib-associated skin rash, the interventional outcomes of severe rash, and impact of severe rash on the outcomes of imatinib treatment in gastrointestinal stromal tumor (GIST) patients.
MATERIALS AND METHODS
A total of 620 patients were administered adjuvant or palliative imatinib for GIST at Asan Medical Center between January 2000 and July 2012. This analysis focused on a group of 42 patients who developed a severe rash requiring major interventions, defined as dose interruption or reduction of imatinib or systemic steroid use.
RESULTS
Of the 620 patients treated with imatinib, 148 patients (23.9%) developed an imatinib-associated skin rash; 42 patients (6.8%) developed a severe rash requiring major intervention. Of these, 28 patients (66.8%) successfully continued imatinib with interventions. Serial blood eosinophil levels during imatinib treatment were associated with skin rash and severity. A significant association was observed between successful intervention and blood eosinophil level at the time of intervention initiation. In metastatic settings, patients with severe rash requiring major interventions tended to show poorer progression-free survival than patients who did not require major intervention and patients with no rash, although this finding was not statistically significant (p=0.326).
CONCLUSION
By aggressive treatment of severe rash through modification of imatinib dose or use of systemic steroid, the majority of patients can continue on imatinib. In particular, imatinib dose intensity can be maintained with use of systemic steroid. Measuring the blood eosinophil levels may be helpful in guiding the management plan for skin rash regarding the intensity and duration of interventions.

Keyword

Imatinib; Gastrointestinal stromal tumors; Exanthema; Eosinophils; Treatment outcome

MeSH Terms

Chungcheongnam-do
Disease-Free Survival
Eosinophils
Exanthema*
Gastrointestinal Stromal Tumors*
Humans
Incidence
Skin*
Treatment Outcome

Figure

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  Fig. 1. Major interventions for rash and outcomes in patients with imatinib-associated severe skin rash.

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  Fig. 2. Association between blood eosinophil count and therapeutic outcomes of the first major interventions for severe skin rash (A) and final outcomes for all major interventions (B). Lines indicate median values.

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  Fig. 3. Serial eosinophil counts in peripheral blood samples during the first year of imatinib treatment in patients with severe skin rash requiring major interventions (group 1), patients with skin rash not requiring major interventions (group 2), and patients without skin rash (group 3). Lines indicate the mean±standard error. *p < 0.05 (Kruskal-Wallis test).

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  Fig. 4. Progression-free survival curves of patients with severe skin rash requiring major interventions (group 1), patients with skin rash not requiring major interventions (group 2), and patients without rash (group 3) while receiving imatinib for unresectable or metastatic gastrointestinal stromal tumor.

Reference

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