Ponatinib-Induced Eruptive Squamous Cell Carcinomas

Document Type

Article

Publication Date

5-21-2025

Abstract

Philadelphia chromosome (Ph), t(9;22), is the most common cytogenetic abnormality in patients diagnosed with acute lymphoblastic leukemia. This is the result of a fusion between the ABL1 gene on chromosome 9 and the BCR gene on chromosome 22, creating an oncoprotein.1 To target this fusion, ponatinib, a BCR:ABL1 tyrosine kinase inhibitor (TKI) with high potency against Ph-positive leukemias, was created.2 Thus, ponatinib was approved to treat acute lymphoblastic leukemia and has shown high efficacy rates.1 Although ponatinib is effective with a 73% 5-year overall survival, there are some notable adverse events of the drug. The main concern for adverse events of ponatinib in the literature is the associated cardiotoxicity. There has also been evidence of severe side effects of ponatinib, including pancreatitis, atrial fibrillation, pneumonia, and angina pectoris.3 However, 1 rare side effect that has seldom been noted in literature is eruptive well-differentiated squamous cell carcinomas (SCCs). This adverse effect has only been previously described with the use of a similar TKI, nilotinib, and has yet to be documented with ponatinib.4,5 Here, we discuss a 78-year-old Caucasian female who presented with a sudden onset of multiple scaly lesions on the bilateral lower extremities after beginning treatment with ponatinib 1 month prior. One punch biopsy and 2 shave biopsies were performed, revealing well-differentiated SCCs. The sudden onset of this severe adverse effect requires prompt monitoring by the medical oncologists and dermatologists involved in the patient’s care to ensure timely intervention. Likewise, it would be beneficial for the physician to counsel the patient on this potential adverse effect before initiating the medication.

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