Acute generalized exanthematous pustulosis during apalutamide treatment in a patient with prostate cancer

Honda, Tomoko; Tohi, Yoichiro; Kaku, Yo; Kimura, Nachino; Kato, Takuma; Haba, Reiji; Dainichi, Teruki; Sugimoto, Mikio

doi:10.1002/iju5.12525

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…Following a comprehensive literature review, we identified 9 reported cases of apalutamide-induced SCARs. These include five cases of TEN [ 4 – 7 ], one case of acute generalised exanthematous pustulosis [ 8 ], and 3 cases of DRESS (two with possible overlapping SJS) [ 9 , 10 ]. The median age of patients included in these cases is 83 years (range = 72–91 years).…”

Section: Literature Reviewmentioning

confidence: 99%

Apalutamide-Induced Toxic Epidermal Necrolysis in a Caucasian Patient with Metastatic Castration-Sensitive Prostate Cancer: A Case Report and Review of the Literature

Flynn,

Liu,

Byrne

et al. 2023

Case Rep Oncol

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Apalutamide is a novel nonsteroidal androgen receptor inhibitor that has been shown to improve outcomes for patients with nonmetastatic castration-resistant prostate cancer and metastatic castration-sensitive prostate cancer when combined with androgen deprivation therapy. Apalutamide-induced skin rash occurred commonly in clinical trials, with 23.8–27.1% of patients experiencing a rash of any grade, and 5.2–6.3% experiencing a rash of grade three or higher. There were no cases of severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) reported in clinical trials; however, there are rare cases reported in the literature with the majority occurring in Asian patients. An 83-year-old Caucasian male was commenced on apalutamide, combined with degarelix, for the management of metastatic castration-sensitive prostate cancer. During week five of apalutamide treatment, the patient developed a widespread erythematous maculopapular rash. On presentation, the rash affected 80% of his body surface area (BSA) and a diagnosis of a severe cutaneous drug eruption was made. He was commenced on methylprednisolone (MP) therapy. Despite 5 days of MP, the rash continued to deteriorate involving 95% of his BSA. Nikolsky’s sign was positive. A diagnosis of overlap SJS/TEN was made, supported by skin biopsy. His SCORTEN score was three. He was then commenced on intravenous immunoglobulin and transferred to the intensive care unit. Over the coming days, the rash began to stabilise, and his steroid dose was weaned. He was discharged from hospital 38 days after rash onset. We report the first suggested case of apalutamide-induced SJS/TEN in a Caucasian patient. We discuss other cases of apalutamide-induced SCARs reported in the literature. Risk factors seem to include low body weight and Japanese race, as well as short time to onset of rash.

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Section: Literature Reviewmentioning

confidence: 99%

Apalutamide-Induced Toxic Epidermal Necrolysis in a Caucasian Patient with Metastatic Castration-Sensitive Prostate Cancer: A Case Report and Review of the Literature

Flynn,

Liu,

Byrne

et al. 2023

Case Rep Oncol

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“…On the basis of previous literature, dermatologic adverse events (dAEs) remain the most reported side effects of apalutamide. Up to now, 15 case reports and 3 retrospective analyses of apalutamiderelated drug eruptions have been published, with a divergent geographic distribution indicating the Japanese most vulnerable to dAEs of apalutamide (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). However, most of the dAEs remain mild and moderate with a fair prognosis (16,17).…”

Section: Introductionmentioning

confidence: 99%

Case report: Apalutamide-induced severe lethal cutaneous adverse effects in China

Wang,

Cao,

Zhang

et al. 2024

Front. Immunol.

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IntroductionApalutamide is a novel agent for castration-resistant prostate cancer while skin rashes are the most common untoward reactions. Up to now, most of the reported dermatologic adverse events (dAEs) allocated to mild and moderate with a fair prognosis. Herein, we report a case series of severe dAEs in China caused by apalutamide.Case presentationThe four patients all developed severe and lethal drug eruptions including Stevens-Johnson syndrome and toxic epidermal necrolysis with a mean incubation period of 40 days. On the basis of the medical condition, all the patients were suggested to withdraw apalutamide and three of them recovered. Of note, attempts of rechallenges of apalutamide may be fatal.DiscussionThe incidence of dAEs in previously conducted clinical trials exceeded 20%, with maculopapular rashes being the most common feature. However, the incidence and severity varied in different geographic regions and ethnicities. Inadequate attention was paid to severe cutaneous adverse reactions. Long latency may easily lead to the misdiagnosis of dAEs, and immediate withdrawal of apalutamide is the cornerstone of therapies.ConclusionSpecial and adequate attention should be paid to apalutamide-attributed severe cutaneous adverse effects. Besides, the prognosis of severe drug eruptions may be disappointing, and in-time withdrawal is vital.

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“…Apalutamide is mainly responsible for benign maculo-papular exanthema (MPE), xerosis, lichenoid reactions [3][4][5]. But potentially life threating condition such as acute generalized exanthematous pustulosis [6], DRESS [7,8] or toxic epidermal necrolysis [3] have been described in the literature. We report two cases from our clinic illustrating the clinical spectrum of the CAE.…”

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confidence: 99%

Cutaneous adverse reactions associated to apalumide: two case reports of DRESS syndrome and maculopapular exanthema

Hallamies,

Auvinen,

Junkkari

et al. 2024

SJU

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Acute generalized exanthematous pustulosis during apalutamide treatment in a patient with prostate cancer

Cited by 6 publications

References 15 publications

Apalutamide-Induced Toxic Epidermal Necrolysis in a Caucasian Patient with Metastatic Castration-Sensitive Prostate Cancer: A Case Report and Review of the Literature

Apalutamide-Induced Toxic Epidermal Necrolysis in a Caucasian Patient with Metastatic Castration-Sensitive Prostate Cancer: A Case Report and Review of the Literature

Case report: Apalutamide-induced severe lethal cutaneous adverse effects in China

Cutaneous adverse reactions associated to apalumide: two case reports of DRESS syndrome and maculopapular exanthema

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