Reactive management

Reactive management of photosensitivity induced by multikinase inhibitor treatment

General recommendation: Preventive measures are the key to avoiding and managing photosensitivity. Broad-spectrum sunscreen and wearing protective sunclothing, sunglasses and hat is essential, with symptomatic treatment as required.

Treatment overview

Protection against sun exposure is recommended for all patients during treatment with multikinase inhibitors,¹ but is vital for patients who develop photosensitivity.

Advise patients taking a drug with a known risk of photosensitivity to minimise sun exposure, wear UV protective clothing and use a broad-spectrum sunscreen containing titanium dioxide or zinc oxide with an SPF of at least 30.^2-4 In some countries, SPF 50 is the standard recommendation. Patients should be aware that photosensitisation can occur through window glass, which does not block UVA radiation.³ For grade 3 photosensitivity reactions (blistering and extensive erythema), oral corticosteroids are indicated together with pain control as appropriate (e.g. narcotics or NSAIDs).⁵ Blisters that rupture can be treated with antibacterial creams to prevent infection.

Multikinase inhibitors

In the case of vandetanib, photosensitivity reactions can occur up to 4 months after discontinuation of treatment; protective measures must be maintained for at least this length of time.⁶

Table 32: Management of photosensitivity associated with multikinase inhibitors ^2-4

Management of photosensitivity
Protective clothing and sunglasses Broad-spectrum sunscreen and lip balm (under all weather conditions) Use mild soap substitutes Emollients (water-based first) Cooling gels or compresses Analgesia if required Topical corticosteroid Antihistamines Oral corticosteroid (if severe) Oral analgesic (NSAID or narcotic) Prevent secondary infection if blisters break (e.g. antibacterial cream) Individualized treatment as appropriate

Management of photosensitivity

Protective clothing and sunglasses
Broad-spectrum sunscreen and lip balm (under all weather conditions)
Use mild soap substitutes
Emollients (water-based first)
Cooling gels or compresses
Analgesia if required
Topical corticosteroid
Antihistamines
Oral corticosteroid (if severe)
Oral analgesic (NSAID or narcotic)
Prevent secondary infection if blisters break (e.g. antibacterial cream)
Individualized treatment as appropriate

NSAID, non-steroidal anti-inflammatory drug; SPF, Sun Protection Factor.

Products

Broad-spectrum sunscreen
Emollients
Cooling gels
Antihistamine
Topical or oral corticosteroids
Topical or systemic analgesics
Antibacterial cream

Multikinase treatment

Continue with/withhold the selected multikinase inhibitor treatment regimen, as recommended in the current and relevant SPC and according to the patient’s condition.

Related Links

Common Terminology Criteria for Adverse Events (CTCAE)

References

Lacouture ME, et al. MASCC Skin Toxicity Study Group. Support Care Cancer. 2011 ; 19 : 1079-95.
Claveau J, et al. Skin Therapy Lett. 2014; 19: 1-4.
Sinha R, et al. Br J Dermatol. 2012; 167: 987-94.
Brose MS, et al. Cancer Treat Rev. 2018;66:64-73
National Cancer Institute Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events and Common Toxicity Criteria [v5.0]. 27 November 2017. (Accessed 15 April 2019).
Food and Drug Administration. Caprelsa (vandetanib) Prescribing Information 2018.