BRIGATINIB INDUCED PHOTOSENSITIVITY

Abstract

<h3>Introduction</h3> Drug-induced photosensitivity is suspected when dermatitis develops in a sun-exposed distribution. Reactions occur by phototoxic, photoallergic, or immune-mediated mechanisms. Brigatinib is an oral tyrosine kinase inhibitor used in the treatment of non-small cell lung cancer. It causes skin rash in 24-40% of patients but is rarely linked with photosensitivity. We present a case of blistering dermatitis suspected secondary to brigatinib. <h3>Case Description</h3> A 65-year-old female with metastatic non-small cell lung cancer on brigatinib for one month presented with a pruritic maculopapular rash without systemic findings. She denied other symptoms or recent illnesses. Vitamin D supplement was the only other medication. Exam was notable for a maculopapular erythematous, partially blanchable rash in a malar distribution, a "V" pattern on the upper chest, flexor surface of arms, dorsal surface of hands with vesicular changes, and erythema of the vaginal labia. Laboratory workup was unremarkable including unchanged chronic mild transaminitis and no peripheral eosinophilia. The rash resolved with brigatinib cessation and mild to moderate potency topical corticosteroids over 2-3 weeks. A month later, brigatinib was reintroduced with sun exposure precautions and without recurrence of rash. <h3>Discussion</h3> We describe a case of suspected photosensitivity drug rash temporally related to use of brigatinib. Photosensitivity has been reported with signal transduction inhibitors, but only one other report is found in literature for brigatinib currently. Given the importance of treatment for this patient, brigatinib was reintroduced at full dose one month following the episode, with careful instructions regarding sun exposure, without rash recurrence.