Efficacy and safety of panitumumab alone or in association with radiotherapy in unresectable cutaneous squamous cell carcinoma.

BACKGROUND: The prognosis of unresectable cutaneous squamous cell carcinomas is very poor. OBJECTIVE: To evaluate the efficacy and safety of panitumumab alone or in association with radiotherapy in the treatment of unresectable cutaneous squamous cell carcinoma. METHODS: This was a monocentre retrospective study of all consecutive patients having received at least two courses of panitumumab, alone or in association with radiotherapy, between 2016 and 2019. The primary endpoint was the rate of best overall response, evaluated according to the RECIST 1.1 criteria. The secondary endpoints were the response and disease control rates at 6 weeks and 6 months, progression-free survival, overall survival and safety. RESULTS: A total of 25 patients were included; their median age was 86 years, and 17 (86%) had a WHO performance status over 2. The best overall response rate was 52%, including four complete responses (16%) and nine partial responses (36%). All patients with complete response and five out of nine patients with partial response had received concurrent radiotherapy, in most cases in moderate to low doses (<40 Gray, 67%). The response rates at 6 weeks and 6 months were 12% and 28%, respectively. The control rates at 6 weeks and 6 months were 84% and 32%, respectively. Median progression-free survival was 6.9 months, and median overall survival was 10.5 months. Grade 3 side-effects, mostly dermatological, occurred in 16 patients (64%). CONCLUSION: These results suggest that panitumumab remains pertinent in the treatment of unresectable cutaneous squamous cell carcinoma, in particular in association with radiotherapy, despite recent advances with anti-PD-1 antibodies. It presents several advantages: it can be used in very elderly or feeble patients, it does not provoke anaphylactic or other irreversible or life-threatening side-effects, and our study observed some long-term responses. Further prospective investigation of anti-EGFR antibodies, in association with anti-PD-1 antibodies and/or chemotherapy, should be conducted.

[Frequency of contact sensitization to modern dressings used to treat chronic leg ulcer]. / Fréquence des sensibilisations de contact aux pansements modernes utilisés sur les ulcères de jambe.

INTRODUCTION: Allergic contact dermatitis around chronic leg ulcers (CLU) is a common complication in patients presenting CLU and prolongs healing times. The aim of this study was to describe the rate of sensitization to modern dressings (MD) used in these patients and to assess whether there is a relation between the number of sensitizations and ulcer type, the time from onset of the ulcer, and patient age and gender. PATIENTS AND METHODS: We conducted a retrospective study at Reims University Hospital between 2010 and 2014 that included all patients with CLU of vascular etiology surrounded by eczematous lesions, and who had one of the patch-tests in the following 3 series: European baseline±leg ulcers±corticosteroids. RESULTS: Among the 73 patients included, 43 % were polysensitized. Thirty-three patients (45 %) were sensitized to MD (38 % to hydrocolloids, 18 % to hydrogels, 7 % to hydrocellular dressings, 7 % to hydrofiber dressings, 5 % to contact layers and 3 % to alginates). Median age and sex did not differ between "polysensitized" patients and "non-polysensitized" patients (P=0.84 and P=0.25, respectively). Polysensitization was more frequent among patients presenting ulcers for more than 5 years (P=0.032). CONCLUSION: Practically half of all patients presenting CLU with surrounding contact dermatitis had sensitization to modern dressings (mostly hydrocolloids and hydrogels). The rate of sensitization increased with the length of presence of CLU.

[Systemic contact dermatitis due to nickel from an intravenous catheter]. / Dermite de contact systémique au nickel induite par un cathéter veineux.

INTRODUCTION: Systemic contact dermatitis is a form of delayed hypersensitivity reaction seen after systemic administration of a hapten in a subject previously sensitised via the cutaneous route. There have been few reports of this condition with nickel. In this paper, we describe four cases ascribable to the presence of nickel in a peripheral venous catheter. PATIENTS AND METHODS: We reviewed the dossiers of four women developing pruriginous exanthema several hours after infusion. The same type of catheter (Optiva) was used in all cases. Epicutaneous tests were performed in all four patients, as well as a challenge test comprising a serum glucose infusion given via the incriminated catheter. Testing for the presence of nickel in the catheter was performed by means of a spot-test. Quantitative nickel assays were performed in vitro using inductively coupled plasma mass spectrometry on the glucose solution infusion kits with eight sample catheters and a negative control kit. RESULTS: The eruptions comprised maculopapular lesions, in some cases vesicular or bullous, arranged symmetrically around the tops of the limbs, the trunk and skin folds, with involvement of the infused forearm in most cases. Two of the four patients had previously presented a number of similar episodes. All four patients exhibited frankly positive test results for nickel and the role of the Optiva) catheter was demonstrated in all four patients by means of a challenge test. The presence of nickel in the catheter was demonstrated by a positive spot-test and was confirmed by quantitative assay demonstrating variations in nickel release for the different samples of the same Optiva) catheter model. DISCUSSION: As with the few reported cases published in the literature, our four cases of systemic contact dermatitis induced by nickel in a catheter all incriminated the same type of catheter and the tests performed clearly demonstrated the causative role of the device. The cases of systemic contact dermatitis were seen chiefly in women in the immediate postoperative period; they could be confused with adverse drug reactions and subsequently lead to inappropriate withdrawal of treatment. The diagnosis, which was suggested by the appearance of the lesions (symmetry, involvement of skinfolds and buttocks, concomitant reaction at the injection site), history of prior episodes and a frankly positive epicutaneous nickel test, may be readily confirmed using a challenge test.

[Tobacco contact dermatitis caused by sensitivity to sorbic acid]. / Eczéma de contact au tabac par sensibilisation à l'acide sorbique.

BACKGROUND: Contact dermatitis caused by tobacco is rare and poorly understood. In this paper, we report what is to our knowledge, the first case of tobacco contact dermatitis with identification of the causative agent. PATIENTS AND METHODS: A 46-year-old man was hospitalised for diffuse dermatitis originating in the left leg. Subsequent epicutaneous tests indicated that this dermatitis was ascribable to sensitisation to the sorbic acid present in Fucidin cream applied around a chronic wound. A persistent plaque of eczema observed on the day of examination opposite the patient's right trouser pocket suggested the implication of tobacco powder with which the pocket was soiled. An epicutaneous test using tobacco (moistened in water) proved positive (++ at 48 and 72 h). This tobacco contained sorbic acid, used as a preservative. DISCUSSION: The positive test for sorbic acid was relevant not only regarding the lesions on the patient's legs (application of a topical cream containing sorbic acid) but also for the lesion on the patient's thigh and for palmar dyshidrosis (through contact with strands of loose rolling tobacco). To our knowledge, this is the first recorded case of contact dermatitis caused by sorbic acid in tobacco.

[Allergic contact dermatitis to the Comfeel hydrocolloid dressing]. / Allergie de contact à l'hydrocolloïde Comfeel(R).

INTRODUCTION: Allergic contact dermatitis is frequent in patients with chronic leg ulcers. However, it rarely occurs with modern wound dressings and is exceptional with hydrocolloids. CASE REPORT: A 66-year-old woman was treated for a leg ulcer with the Comfeel plus(R) transparent hydrocolloid dressing for two months. She developed a pruriginous, erythematous and vesiculous dermatitis under the hydrocolloid plaques. Patch tests for the Comfeel plus(R) transparent hydrocolloid, the Comfeel plus(R) hydrocolloid, balsam of Peru and epoxy resin were positive. Only the positive test for the Comfeel plus(R) transparent hydrocolloid was clinically pertinent. The histological examination of the positive test was suggestive of eczema. DISCUSSION: To our knowledge, allergic contact dermatitis to Comfeel plus(R) hydrocolloid dressings has not been reported. Most previous studies which included systematic patch-testings in patients with leg ulcers showed high sensitization rates for various allergens, but no allergy to hydrocolloids. Only isolated cases of allergic contact dermatitis to another hydrocolloid (Duoderm E(R)) have been reported. Our case report shows that allergic contact dermatitis is a possible side-effect of Comfeel plus(R) hydrocolloid dressings. However, it seems exceptional. Since the patch-tests failed to identify the constituent responsible for this allergy in our observation, comprehensive allergologic investigations should be repeated in further cases.