A retrospective multicenter case series published by Patil et al in JAMA Dermatology found high-dose oral vitamin D therapy to be associated with rapid symptomatic and objective improvement in chemotherapy- and radiation therapy–induced skin toxicities, without treatment-related adverse events.
“Severe cutaneous toxic effects from chemotherapy and radiation [therapy] often require treatment interruptions,” the investigators commented. “This case series shows that as cancer treatments grow increasingly complex, incorporating [high-dose oral vitamin D] into supportive care protocols may minimize treatment interruptions, mitigate cutaneous toxic effects, and improve patient outcomes.”
Study Details
The investigators evaluated 33 patients (mean age = 60.9 years; 19 [58%] female), including 28 (85%) with toxic erythema of chemotherapy and 5 (15%) with acute radiation dermatitis, who were treated at three academic medical centers between December 2021 and January 2024. Patients received one or two 100,000-IU doses of oral cholecalciferol or ergocalciferol and had at least 10 days of follow-up.
As primary outcomes, the investigators assessed time to patient-reported symptomatic relief and clinician-assessed objective improvement in erythema (using a 5-point Likert scale). Changes in serum calcium levels and the ability to continue anticancer therapy were evaluated as secondary outcomes.
Key Findings
Within 10 days of treatment, 26 of 30 patients (87%) reported subjective symptom relief, and 23 (77%) had clinician-confirmed clinical improvement. The median time to improvement was 5 days (range = 1–28 days) overall and 3 days (range = 1–16 days) among the 12 inpatients. The mean Likert erythema score decreased over the 10-day follow-up, from 4.36 at baseline to 2.21. The most rapid responses were observed among patients with neutrophilic eccrine hidradenitis and Stevens-Johnson syndrome/toxic epidermal necrolysis–like subtypes.
The investigators reported no meaningful changes in serum calcium levels, and 24 of 33 patients (73%) continued anticancer therapy without interruption. No treatment-related adverse events were documented.
“Patients who received high-dose oral vitamin D therapy were subsequently noted to have rapid improvement in radiation [therapy]– and chemotherapy-related toxic effects of the skin without any substantial safety concerns,” the investigators concluded. “[High-dose oral vitamin D] warrants further exploration to define its role in the evolving oncodermatology landscape, where rapid, effective, and safe interventions are urgently needed, particularly for toxic effects from chemotherapy and radiation [therapy].”
Christopher Iriarte, MD, of Beth Israel Deaconess Medical Center, Boston, is the corresponding author of the JAMA Dermatology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
