Drug-induced Hypersensitivity Syndrome by EGFR-TKI in a Patient with Lung Cancer

Abstract

An 83-years-old woman diagnosed with advanced Epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma was administered afatinib as a first-line treatment. On Day 17, the patient presented with grade 3 diarrhea and a blood test analysis showed an increased inflammatory response. Afatinib treatment was discontinued on the same day. On Day 26, the patient displayed blepharedema and multiple irregular erythema covering her entire body. Drug-induced hypersensitivity syndrome (DIHS) was suspected, and the systemic administration of 30 mg/day prednisolone was administered. The symptoms subsided thereafter. A blood test analysis 3 weeks after onset revealed a reactivation of Human herpesvirus 6 (HHV-6) and a diagnosis of DIHS due to afatinib therapy was confirmed.

Risk of immune system and skin and subcutaneous tissue related adverse events associated with oxaliplatin combined with immune checkpoint inhibitors: a pharmacovigilance study

“…In platinum-based chemotherapy regimens, a preparation of 5-fluorouracil, epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) or vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGFR-TKI) is commonly used simultaneously, and these drugs can also cause ISA-ADEs ( Oyama et al, 2021 ; Moret et al, 2022 ). In our study, however, we first qualified the identity of the target drug, that is, explained that it had to be a PS or SS in the report, thus ensuring the role of oxaliplatin in the occurrence of each ISA-ADE while reducing the effect of other drugs on the outcome.…”

Mechanism of Lethal Skin Toxicities Induced by Epidermal Growth Factor Receptor Inhibitors and Related Treatment Strategies

“…Using the existing evidence for prevention and treatment should be an area of interest for medical staff and scientific researchers. EGFR inhibitors withdrawal; oral prednisolone (0.5 mg/kg/day); cyclosporine (5 mg/kg/day) (41,167) This paper summarized the cellular and molecular mechanisms of EGFR signaling and adverse skin reactions caused by EGFR inhibitors to provide ideas for the use of EGFR inhibitors and the prevention of related skin toxicity in cancer treatment. Effectively preventing and treating skin toxicity without damaging the anti-tumor efficacy of EGFR inhibitors is the ultimate goal we want to achieve.…”

“…Clinical manifestations and therapeutic measures of severely fatal skin toxicities. sterile non-follicular pustules on the base of the erythema, leukocytosis, neutrophils ≥7000, mild eosinophilia, multiple organs involved(89,162) EGFR inhibitors withdrawal; topical corticosteroids, systemic antihistamines (162, 163) TEN Fever≥38°C, influenza-like syndrome, respiratory tract symptoms, Lymphopenia, transitory neutropenia, mild cytolysis, blisters, multiple organs involved, Nikolsky's sign, skin detachment ≥30% extensive rash, atypical lymphocytosis, eosinophilia, lymphadenopathy, multiple organ dysfunction, reactivation of human herpes virus 6 and human herpes virus 7(35,41) …”

Table1.DOCX

“…In platinum-based chemotherapy regimens, a preparation of 5-fluorouracil, epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) or vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGFR-TKI) is commonly used simultaneously, and these drugs can also cause ISA-ADEs (Oyama et al, 2021;Moret et al, 2022). In our study, however, we first qualified the identity of the target drug, that is, explained that it had to be a PS or SS in the report, thus ensuring the role of oxaliplatin in the occurrence of each ISA-ADE while reducing the effect of other drugs on the outcome.…”