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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