Drug-Induced Subacute Cutaneous Lupus Erythematosus Associated with Nab-Paclitaxel Therapy

Abstract

by fluorescence in situ hybridization. Computed tomography imaging revealed lesions in keeping with small-volume lung and liver metastases and bilateral ovarian metastases.The patient was therefore started on first-line systemic therapy for metastatic breast cancer, using nanoparticle albumin bound (nab)-paclitaxel 260 mg/m 2 intravenously every 21 days. She initially tolerated the nab-paclitaxel well, with toxicities limited to alopecia and mild fatigue. After the third infusion, she developed a new skin eruption consisting of several ill-defined erythematous papules located symmetrically over the extensor surfaces of her arms. No pruritus, pain, or constitutional symptoms accompanied these skin lesions. In addition, the patient had no history of a known inciting exposure, significant sun exposure, or local trauma. She had no past history of photosensitivity, dermatoses, smoking, or rheumatic disease.The skin lesions progressed over the subsequent weeks, though the patient remained otherwise asymptomatic. At the assessment preceding the patient's 5th cycle of nab-paclitaxel, the skin eruption was noted to have progressed dramatically. Physical examination now showed a symmetrical, photodistributed rash involving the extensor surfaces of both arms and hands, as well as the anterior chest (Figure 1). The skin lesions were psoriasiform and consisted of erythematous papules coalescing into plaques with overlying scale (Figure 2). No demonstrable mucous membrane involvement, nail changes, or other skin lesions were evident. The remainder of the physical examination was remarkable only for findings of the known breast cancer.The current eruption was felt, clinically, to be in keeping with subacute cutaneous lupus erythematosus (scle). Upon review, the patient was not taking any medications known to be associated with scle. Her chronic medications included losartan, atorvastatin, and pantoprazole. In addition to nabpaclitaxel, she had recently used metoclopramide as needed for nausea. ABSTRACTDrug-induced lupus erythematosus (dile) syndromes are documented complications of chemotherapeutic agents, including paclitaxel. Subacute cutaneous lupus erythematosus (scle) is a distinct dile syndrome presenting with characteristic annular or papulosquamous skin lesions in a photosensitive distribution with associated high anti-ssa titres. Previously, dile syndromes complicating paclitaxel therapy have been attributed to polyethoxylated castor oil (Kolliphor EL: BASF, Ludwigshafen, Germany), the biologic solvent included in the drug's original formulation (Taxol: Bristol-Myers Squibb, Montreal, QC), rather than the parent chemotherapy molecule. Here, we report a characteristic case of drug-induced scle complicating treatment with nanoparticle albumin bound (nab)-paclitaxel (Abraxane: Celgene, Summit, NJ, U.S.A.), a solvent-free taxane formulation. The pertinent English-language literature is also discussed. This case report is the first to link solvent-free paclitaxel with scle, and it suggests that the parent molecule is respo...

Dermatological adverse events with taxane chemotherapy

“…The incidence of rash is comparable to that observed with the solvent-based paclitaxel (overall incidence of 4%), except in Asian populations where it appeared to affect more than a third of patients in some series [158, 160]. Nab-paclitaxel-induced SCLE is similar in all aspects to that observed with paclitaxel ( see above ) [54]. Photosensitivity reaction can also occur [161].…”

“…SCLE has also been reported with nab-paclitaxel, portraying the same clinical, histological or laboratory abnormalities [54]. …”

Taxanes‐induced cutaneous eruption: another histopathologic mimicker of malignancy

“…12,13 Gallo et al 14 reported three cases of eccrine squamous syringometaplasia secondary to docetaxel related to extravasation of the drug during the infusion and revised other similar cases, [15][16][17][18][19][20][21] concluding that it could be a frequent, but unreported histopathologic finding. Taxane-associated photosensitivity has been reported as photo recall phenomenon, [22][23][24][25] photo-onycholysis, erythema multiforme and onycholysis 23 and subacute cutaneous lupus erythematosus, [26][27][28][29][30][31][32][33] associated or not to systemic lupus erythematosous. 28,31 The photo recall phenomenon is characterized by a drug-induced skin rash located on a previously sunburned area that occurs between 1 and 8 days after the sunburn and between 1 day and 1 week after drug administration.…”

Intravesicular taxane‐induced dermatotoxicity in a 78‐year‐old man with urothelial carcinoma and primary cutaneous anaplastic large cell lymphoma

“…More rarely, life‐threatening cutaneous eruptions, including erythema multiforme, Stevens‐Johnson syndrome and toxic epidermal necrolysis may occur in association with systemic taxane administration . Other cutaneous manifestations include erythrodysesthesias, drug‐induced lupus erythematosus, photosensitivity reactions and scleroderma‐like changes . However, despite the immense literature documenting the various toxicities of systemic taxane administration, systemic toxicities resulting from topical therapy, such as intravesical therapy, have not been reported.…”