Skin Hypopigmentation in a Patient with Papillary Carcinoma Thyroid Treated with Sorafenib

Athira Raju, Mathews Jose, Arun Philip and Keechilat Pavithran*

Skin Hypopigmentation in a Patient with Papillary Carcinoma Thyroid Treated with Sorafenib. Sorafenib is an oral multikinase inhibitor approved for the treatment of advanced renal cell carcinoma, hepatocellular carcinoma and thyroid cancer. The dermatological side effects of sorafenib include palmar-plantar erythrodysesthesia, alopecia, skin rash, pruritus, xeroderma and erythema.

Here we report a case of skin hypopigmentation related to sorafenib therapy. A 60 year old male with papillary carcinoma of thyroid with cervical lymph nodal metastasis, post thyroidectomy and Iodine-131 ablation therapy developed lung metastasis. After 4 months of treatment with 800 mg/day he developed hypopigmentation.

He was also having grade 2 mucositis, so dose was reduced to 400 mg/ day. Later his disease progressed, so sorafenib was discontinued. However, the hypopigmented lesions persisted.
Sorafenib is an oral multikinase inhibitor which has antiangiogenic and proapoptotic activity. Sorafenib is a potent inhibitor of the C-RAF and B-RAF kinases, as well as the Vascular Endothelial Growth Factor Receptor, and Platelet-Derived Growth Factor Receptor. Such an inhibition works in two way- anti-proliferative activity targeting the tumor cell and indirectly through the inhibition of angiogenesis.

Sorafenib causes a variety of side effects including: gastrointestinal, dermatological, constitutional, cardiovascular and pulmonary events. In most of the cases, the adverse events are grade 1-2 and decrease over time. Observations from clinical trials and clinical practice with the long-term use of sorafenib suggests that unexpected adverse events and cumulative toxicity are of no major concer. Among the plethora of adverse events reported with sorafenib, hypopigmentation of skin is probably the rarest. A good understanding of the possible adverse events of the drug is essential in clinical practice. Although not alarming as some of the other adverse effects of sorafenib, hypopigmentation of skin can certainly affect the quality of life in our patients.

Cancer Stud Mol Med Open J. 2015; 2(2): 72-74. doi: 10.17140/CSMMOJ-2-110