Brigatinib
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Phototoxic reaction: case report A 70-year-old woman developed phototoxic reaction during treatment with brigatinib for metastatic lung adenocarcinoma and meningioma. The woman had been receiving oral brigatinib 180 mg/day for 6 months and levetiracetam for 10 years. She presented with a 2.5-months history of pruritic eczematous eruption similar to an exaggerated sunburn involving the neck, face, forearms and hands, sparing non-sun-exposed areas. Pruritus was minor and limits were not very sharp. She denied exposure to any photosensitising drugs or airborne chemicals. The woman’s treatment with brigatinib was discontinued. She received treatment with methylprednisolone. Her clinical condition improved. Patch test and photopatch tests within a month with brigatinib (30mg pill smashed and incorporated at 30% in petrolatum and with a drop of water) and levetiracetam showed negative results. In photopatch tests, no immediate reaction was observed; however, within 24–48h, the irradiated area showed a sharply limited and uniform bright erythema. After the results, she admitted that she had again started brigatinib 180 mg/day, despite previously being informed to discontinue the drug. Skin biopsy showed a spongiotic pattern with focal necrosis of the epidermis compatible with a phototoxic reaction. Later, photopatch tests were performed with brigatinib in different concentrations with 2 and 5 J/cm2 of UVA to exclude photoallergy. However, she again took brigatinib 90mg two days prior to the photopatch test. Two days after UV irradiation, she developed a faint erythema in the area irradiated with 5 J/cm2 but not with 2 J/cm2, which was suggestive of a response dependent on the UV dose and the dose of the drug taken orally. Additionally, a biopsy showed focal epidermal necrosis along with a positive photoprovocation test, which was dose dependent of the drug used and on the dose of UVA irradiation. Based on these findings, a diagnosis of phototoxic reaction was made. Considering advanced cancer disease, the high beneficial effect of the drug and the lack of other therapeutic options, the woman was restarted on brigatinib 90 mg/day and sun avoidance was recommended. Eventually, she developed a slight and tolerable erythema on the photo-exposed areas, but with regular surveillance brigatinib treatment was continued. Author comment: "We report a case of a photosensitive drug reaction related to brigatinib, very probably due to phototoxicity." Morgado F, et al. Phototoxic reaction to brigatinib - a new photosensitizing drug. Journal of the European Academy of Dermatology and Venereology 33: e491-e492, No. 12, Dec 2019. Available from: URL: http://doi.org/10.1111/ 803442410 jdv.15818 - Portugal
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Reactions 4 Jan 2020 No. 1785
