Necrosis of Skin Autograft on Sutent - 14 yo with ASPS

Fictional · Post by **Fictional** » Wed Jun 09, 2010 7:47 am

Klin Padiatr. 2010 May;222(3):184-6. Epub 2010 May 31.
Something to be aware of - I signed up for a Google Alert on "alveolar soft part sarcoma". Looks like this poor gal had necrosis of a skin graft after she was put on Sutent post-operatively. I think some people in our forum have been on Sutent after surgery - and done all right - but this is a caution. In our case, we were on Sutent before surgery (stopped 2 weeks) and it was not continued afterward.

Link for the article: http://www.ncbi.nlm.nih.gov/pubmed/20514624 (abstract posted below).

Necrosis of a skin autograft after short-term treatment with sunitinib in a 14-year-old girl with metastatic alveolar soft part sarcoma of the thigh.

Hanzer M, Nebl A, Spendel S, Pilhatsch A, Urban C, Benesch M.

Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical University of Graz, Graz, Austria. marie.hanzer@medunigraz.at
Abstract

A 14-year-old girl was diagnosed with alveolar soft part sarcoma (ASPS) of the thigh and lung metastases. She underwent tumor resection and pulmonary metastasectomy followed by hyperfractionated local radiotherapy (44.8 Gy). A mesh graft transplant was used to cover the postoperative skin defect on the thigh. Since ASPS do not respond to conventional chemotherapy antiangiogenic treatment with peginterferon alfa-2b and thalidomide was started. Immunohistochemical analysis of tumor tissue showed expression of vascular endothelial growth factor receptors (VEGFR) 1, 2, 3, and platelet derived growth factor receptor (PDGFR)-alpha and -beta. Hence, additional treatment with multitargeted receptor tyrosine kinase inhibitor sunitinib (Sutent) was started on a compassionate use basis. 2 weeks later the patient presented with necrosis of the skin transplant requiring necrectomy and skin grafting. This case illustrates that drugs inhibiting vascular endothelial growth factor receptors have to be used very cautiously in cancer patients with severe pre-existing skin damage.