{"id":1940,"date":"2012-10-01T01:00:00","date_gmt":"2012-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/complications-cutanees-neoplasiques-du-sorafenib-discussion-autour-dun-cas-de-carcinome-spinocellulaire-chez-un-patient-traite-pour-carcinome-hepato-cellulaire\/"},"modified":"2018-10-20T18:40:01","modified_gmt":"2018-10-20T16:40:01","slug":"complications-cutanees-neoplasiques-du-sorafenib-discussion-autour-dun-cas-de-carcinome-spinocellulaire-chez-un-patient-traite-pour-carcinome-hepato-cellulaire","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/complications-cutanees-neoplasiques-du-sorafenib-discussion-autour-dun-cas-de-carcinome-spinocellulaire-chez-un-patient-traite-pour-carcinome-hepato-cellulaire\/","title":{"rendered":"Complications cutan\u00e9es n\u00e9oplasiques du soraf\u00e9nib: discussion autour d’un cas de carcinome spinocellulaire chez un patient trait\u00e9 pour carcinome h\u00e9pato-cellulaire"},"content":{"rendered":"

2012<\/strong><\/p>\n

DUPUY Marie, URSIC-BEDOYA Jos\u00e9, KHEMISSA Faiza, AMOUROUX Caroline, REMY Andr\u00e9-Jean<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02012-05-04 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Observation: un patient ag\u00e9 de 70 ans \u00e9tait suivi dans notre service pour une hepatite chronique B au stade de cirrhose trait\u00e9e par lamivudine puis, du fait d\u2019un \u00e9chappement, par ent\u00e9cavir avec une n\u00e9gativation de la charge virale soutenue. En mai 2011, le bilan montrait une cirrhose child A6, une AFP normale, \u00e0 la TDM il existait une plage nodulaire hypodense d\u2019environ 20 mm plus marqu\u00e9e au temps portal. Une IRM \u00e9tait rapidement r\u00e9alis\u00e9e et montrait un nodule en hypersignal spontan\u00e9 du secteur IV avec hypervascularisation au temps pr\u00e9coce et aspect en cocarde en temps tardif. Il existait de multiples images nodulaires de petites taille hypervascularis\u00e9es au temps art\u00e9riel et infra-centim\u00e9triques.
\nLe diagnostic de carcinome hepatocellulaire \u00e9tait port\u00e9 selon les crit\u00e8res de Barcelone. Apr\u00e8s RCP, les traitements par chirurgie, transplantation ou chimioembolisation ont \u00e9t\u00e9 recus\u00e9s et il a \u00e9t\u00e9 decid\u00e9 d\u2019un traitement par sorafenib. Le patient \u00e9tait donc inclus dans un essai th\u00e9rapeutique (prodige 11) . Il a \u00e9t\u00e9 randomis\u00e9 dans le bras sorafenib associ\u00e9 \u00e0 la pravastatine. Le traitement \u00e9tait d\u00e9but\u00e9 en mai 2011. La tol\u00e9rance clinique \u00e9tait satisfaisante avec une asth\u00e9nie grade 2. Deux mois apr\u00e8s l\u2019initiation du traitement une nodule cutan\u00e9 apparaissait au dessus de la l\u00e8vre et augmentait de taille progressivement. Devant cet aspect suspect une ablation \u00e9taitt programm\u00e9e et l\u2019histologie d\u00e9finitive concluait \u00e0 un cacinome epidermoide diff\u00e9renci\u00e9 keratinisant infiltrant. Le traitement par sorafenib a \u00e9t\u00e9 interrompu. Lepatient est toujours vivant en mai 2012, sans r\u00e9cidive.<\/p>\n

Discussion : Nous rapportons un cas de carcinome spinocellulaire cutan\u00e9 apparu 3 mois apr\u00e8s l\u2019instauration d\u2019un traitement par Sorafenib. Le sorafenib est un traitement anti-angiog\u00e9nique utilis\u00e9 pour les carcinomes r\u00e9naux et h\u00e9patiques. Ses effets ind\u00e9sirables cutan\u00e9s \u00e0 court terme sont bien connus. \u00c0 plus long terme, la survenue de k\u00e9ratoacanthomes a r\u00e9cemment \u00e9t\u00e9 rapport\u00e9e(1) et plus rarement, celle de carcinomes spinocellulaires infiltrants (2,3)
\n Les d\u00e9lais rapport\u00e9s de survenue sont de 1 \u00e0 9 mois et la physiopathologie n\u2019est pas compl\u00e8tement \u00e9lucid\u00e9e. Le sorafenib agit directement sur les fonctions des cellules dendritiques en r\u00e9duisant la s\u00e9cr\u00e9tion de cytokines. L\u2019inhibition du vascular endothelial growth factor (VEGF) peut \u00e9galement entra\u00eener des modifications du ph\u00e9notype des cellules tumorales, avec un accroissement des mutations Ras oncog\u00e9niques jouant un r\u00f4le important dans la voie de signalisation Ras\/Raf\/Mek et MAP kinases impliqu\u00e9e dans la carcinogen\u00e8se cutan\u00e9e.
\n Notre patient n\u2019avait pas de facteurs de risque tels que l\u2019exposition au soleil et aucun signe de infection par le papilloma virus n\u2019avait \u00e9t\u00e9 retrouv\u00e9 sur l\u2019histologie. <\/p>\n

Conclusion : Notre cas clinique vient \u00e9tayer les cas de la litt\u00e9rature rapportant une relation \u00e9troite entre la prise de Sorafenib et la survenu d\u2019un carcinome spinocellulaire. Le m\u00e9canisme d\u2019action reste inconnu et demande des \u00e9tudes prospectives plus larges. Une surveillance cutan\u00e9e r\u00e9guli\u00e8re par un dermatologue doit \u00eatre pr\u00e9conis\u00e9e \u00e0 tous les patients sous sorafenib<\/p>\n

(1) Dermatologic symptoms associated with the multikinase inhibitor sorafenib.
\nRobert C, Mateus C, Spatz A, Wechsler J, Escudier B. J Am Acad Dermatol. 2009 Aug;61(2):360-1
\n (2) Cutaneous squamous cell carcinoma and inflammation of actinic keratoses associated with sorafenib.
\nDubauskas Z, Kunishige J, Prieto VG, Jonasch E, Hwu P, Tannir NM.
\nClin Genitourin Cancer. 2009 Jan;7(1):20-3
\n(3) Keratoacanthomas and squamous cell carcinomas in patients receiving sorafenib.
\nArnault JP, Wechsler J, Escudier B, Spatz A, Tomasic G, Sibaud V, Aractingi S, Grange JD, Poirier-Colame V, Malka D, Soria JC, Mateus C, Robert C. J Clin Oncol. 2009 Aug 10;27(23):e59-61. Epub 2009 Jul 13<\/p>\n","protected":false},"excerpt":{"rendered":"

2012 DUPUY Marie, URSIC-BEDOYA Jos\u00e9, KHEMISSA Faiza, AMOUROUX Caroline, REMY Andr\u00e9-Jean H\u00e9patologie – \u00a02012-05-04 –\u00a0CO – ________________________________ Observation: un patient ag\u00e9 de 70 ans \u00e9tait suivi dans notre service pour une hepatite chronique B au stade de cirrhose trait\u00e9e par lamivudine puis, du fait d\u2019un \u00e9chappement, par ent\u00e9cavir avec une n\u00e9gativation de la charge virale […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[23],"class_list":["post-1940","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-23"],"yoast_head":"\nComplications cutan\u00e9es n\u00e9oplasiques du soraf\u00e9nib: discussion autour d'un cas de carcinome spinocellulaire chez un patient trait\u00e9 pour carcinome h\u00e9pato-cellulaire - 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