{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:28:06Z","timestamp":1785767286040,"version":"3.56.0"},"reference-count":32,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,2,14]],"date-time":"2020-02-14T00:00:00Z","timestamp":1581638400000},"content-version":"unspecified","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Immunother Cancer"],"accepted":{"date-parts":[[2020,1,9]]},"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Immune checkpoint inhibitors such as nivolumab and targeted BRAF inhibitors have dramatically altered the treatment outcomes of metastatic melanoma over the past few years. Skin toxicity is the most common adverse event (AE) related to the commonly used BRAF inhibitor vemurafenib, affecting more than 90% of patients. Vemurafenib-related severe AEs with early onset are reported in patients who were previously treated with anti-programmed cell death-1 (anti PD-1) antibodies. A prolonged administration of systemic steroids is the first-line treatment of severe or life-threatening AEs. We report the case of a woman suffering from vemurafenib-related severe, rapidly worsening Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome, resolved in a few hours after single-dose administration of a combination of TNF-\u03b1 antagonist infliximab with interleukin (IL)-6 receptor antagonist tocilizumab.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case presentation<\/jats:title>\n                  <jats:p>A 41-year-old woman treated with single-agent nivolumab presented with a melanoma progression. Biopsy samples were revised, revealing a BRAF V600E mutation. The patient was started on vemurafenib and cobimetinib treatment only 10 days after the last administration of nivolumab. On the third day of anti-BRAF therapy, profound lymphopenia was detected, and maculopapular eruption appeared afterward. Subsequently, the clinical conditions deteriorated further, and the woman was admitted on an emergency basis with high fever, respiratory and cardiocirculatory failure, diffuse rash, generalized edema, and lymphadenopathy. Diagnosis of DRESS syndrome with overexpressed capillary leakage was made. A single dose of tocilizumab was administered with an improvement of cardiocirculatory and renal function in a few hours. Because of worsening of liver function, skin lesions and mucositis, a single dose of infliximab was prescribed, and dramatic improvement was noted over the next 24\u2009hours. Dabrafenib and trametinib were initiated, and coinciding with washout of infliximab from the patient\u2019s blood, the drug toxicity recurred.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Anti-IL-6 and anti-TNF-\u03b1 target treatment of very severe AEs may afford an immediate resolution of potentially life-threatening symptoms and reduce the duration and the costs of hospitalization. Maintenance of therapeutic infliximab blood concentrations permits an early switch to dabrafenib after vemurafenib-related AEs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jitc-2019-000388","type":"journal-article","created":{"date-parts":[[2020,2,17]],"date-time":"2020-02-17T03:55:26Z","timestamp":1581911726000},"page":"e000388","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Rapid recovery of postnivolumab vemurafenib-induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome after tocilizumab and infliximab administration"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0934-1875","authenticated-orcid":false,"given":"Natalia","family":"Maximova","sequence":"first","affiliation":[{"name":"Bone Marrow Transplant Unit, Institute for Maternal and Child Health\u2014IRCCS Burlo Garofolo, Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Maestro","sequence":"additional","affiliation":[{"name":"Pharmacy and Clinical Pharmacology Unit, Institute for Maternal and Child Health\u2014IRCCS Burlo Garofolo, Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Zanon","sequence":"additional","affiliation":[{"name":"Pharmacy and Clinical Pharmacology Unit, Institute for Maternal and Child Health\u2014IRCCS Burlo Garofolo, Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Marcuzzi","sequence":"additional","affiliation":[{"name":"Department of Chemical and Pharmaceutical Sciences, University of Ferrera, Ferrera, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,2,16]]},"reference":[{"key":"2025100302494459000_8.1.e000388.1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/978-3-319-91442-8_6","article-title":"Vemurafenib","volume":"211","author":"Garbe","year":"2018","journal-title":"Recent Results Cancer Res"},{"key":"2025100302494459000_8.1.e000388.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12885-017-3626-5","article-title":"Vemurafenib plus cobimetinib in unresectable stage IIIC or stage IV melanoma: response monitoring and resistance prediction with positron emission tomography and tumor characteristics (REPOSIT): study protocol of a phase II, open-label, multicenter study","volume":"17","author":"van der Hiel","year":"2017","journal-title":"BMC 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