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 |