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Table 2 Rash Treatment and Outcome

From: Cutaneous adverse reactions in B-RAF positive metastatic melanoma following sequential treatment with B-RAF/MEK inhibitors and immune checkpoint blockade or vice versa. A single-institutional case-series

Patient

Supportive Measures

Treatment

Total Steroid Duration

Duration of Rash

Targeted Therapy Re-initiation

Additional Therapies

Disease Status after Rash

1

IVFs

Dexamethasone 10 mg q6h inpatient then prednisone 1 mg/kg followed by extended taper outpatient

42 days prescribed (however remained on steroids for entire duration of targeted therapy)

39 days

Yes, D/T 44 days after rash onset On prednisone 10 mg daily

Temozolomide

Mixed response at 1 month, significantly worsened disease at 2 months

2

IVFs

Prednisone 150 mg daily inpatient followed by extended taper outpatient

53 days

37 days

Yes, D/T 39 days after rash onset On prednisone 10 mg daily

Ipilimumab Pembrolizumab CD40 agonist/ Pembrolizumab

Mixed response at 1 month, stable disease at 1 year, worsened disease at 18 months

3

IVFs

Methylprednisolone 50 mg daily inpatient followed by prednisone 60 mg daily with extended taper outpatient

17 days after first rash onset For duration of targeted therapy after rash recurrence

16 days

Yes, V/C (dose reduced) 24 days after rash onset Off prednisone Immediate fever and rash, held additional 13 days then restarted while on prednisone 30 mg daily

None

Mixed response at 1 month, improved disease at 4 months, worsened systemic disease at 8 months, worsened intracranial disease at 9 months

4

None

Prednisone 20 mg daily for 3 days, 10 mg daily for 3 days

6 days

12 days

Yes, V/C 13 days after rash onset Off prednisone Recurrence of rash after 1st dose, discontinued again Restarted 59 days after rash onset Immediate grade 4 allergic reaction to vemurafenib Tolerated D/T 166 days after initial rash onset when started with concurrent steroids

Temozolomide D/T Ipilimumab

Improved disease at 1 month, mixed response at 3 months (before temozolomide), worsened disease at 5 months (on temozolomide) improved response at 9 months (after initiation of D/T), worsened disease at 13 months

5

IVFs, Vasopressors

Methylprednisolone 70 mg BID inpatient followed by prednisone 60 mg daily with extended taper outpatient

54 days at time of readmission for rash recurrence when tapered to prednisone 5 mg daily, prolonged taper again thereafter

15 days

No

Temozolomide

Disease progression at 2 months (before temozolomide), worsened disease at 5 months

6

None

Prednisone 10 mg daily followed by extended taper

Ongoing (> 50 days)

6 days

Yes, V/C 7 days after rash onset On prednisone 10 mg daily

None

No disease progression

  1. IVFs Intravenous fluids, V Vemurafenib, C Cobimetinib, D Dabrafenib, T Trametinib