Efeitos colaterais cutâneos de quimioterapia com taxanos: O ponto de vista do dermatologista

Abstract

Abstract:Chemotherapy with taxanes has recently become part of the treatment for many advanced neoplastic diseases, specially breast and lung cancer. Their main noncutaneous adverse reactions include neutropenia and mucositis, which eventually lead to drug discontinuation. Cutaneous adverse reactions are frequent and significantly interfere with the patient's quality of life. Treatments are poorly effective, but special recommendations may improve symptoms and prevent relapses requiring drug rechallenge. Keywords: Drug Eruptions; Drug Therapy; Cutaneous adverse reactions; Paclitaxel; Taxoids Resumo: Taxanos são drogas quimioterápicas cada vez mais utilizadas no tratamento adjuvante de um grande número de cânceres, principalmente câncer de mama e de pulmão. Os efeitos colaterais não cutâ-neos mais importantes e limitantes do uso destas drogas são neutropenia e mucosite. Os efeitos colaterais cutäneos, além de muito frequente, interfere de forma importante na qualidade de vida dos doentes. Não existem tratamentos totalmente eficazes, mas algumas orientações podem diminuir os sintomas e prevenir recidivas em novas sessões de quimioterapia. Palavras-chave: Erupção por droga; Paclitaxel; Quimioterapia; Taxóides; Toxicidade de drogas ©2011 by Anais Brasileiros de Dermatologia CASE REPORT INTRO DUC TIONTaxanes (TX) are drugs used to treat seve ral types of neo pla sias, such as breast and lung can cer. There are 2 types of TX in Brazil: pacli ta xel (PC) (Taxol ® ) and doce ta xel (DC) ( Taxotere ® ). The most com mon side effects of these drugs are neu tro pe nia and muco si tis. They pre sent a simi lar mode of action but a dis tinct pro fi le regar ding cuta neous adver se reac tions.1 With the pur po se of making der ma to lo gists more fami liar with this kind of reac tion, which will beco me more fre quent with grea ter uti li za tion of TX, we report below 4 cases that were fol lo wed in a derma to logy offi ce. CASE REPORT1 -Female patient, 54 years old, after 4 years of breast can cer treat ment with mas tec tomy and che mothe rapy (CTH) with other drugs, pre sen ted bone and liver metas ta ses; a new CTH series was star ted with PC and car bo pla tin. Two months later she pre sen ted erythe ma and hyperch ro mia on the back of hands and on the face, accom pa nied by dyses the sia with local burning sen sa tion (Figure 1). She wore a mois tu ri zer and pho to pro tec tor, and was orien ted to avoid sun exposu re. Two months later, in view of the inten sity of cuta neous adver se reac tions, PC was repla ced by DC, with great impro ve ment of symptoms. After 2 cycles of the new drug, she deve lo ped phle bi tis at the place of infu sion with linear hyper pig men ta tion fol lo wing the venous path way (Figure 2). The ele men tary lesions of this second epi so de were simi lar to those obser ved in the first. She was trea ted with creams com po sed of tre ti noin/hydro qui no ne/fluo ci no lo ne on the face and

Paclitaxel-associated reticulate hyperpigmentation: Report and review of chemotherapy-induced reticulate hyperpigmentation

“…Cutaneous adverse effects of paclitaxel (and nab-paclitaxel) include alopecia, erythema multiforme, hand-foot syndrome (acral erythema), hypersensitivity reaction, mucositis, nail changes, photosensitivity reactions, and subacute lupus erythematosus[15-22]. In addition to the woman with metastatic breast cancer described in this report, paclitaxel-induced reticulate hyperpigmentation occurred in another woman with metastatic breast cancer and a woman with metastatic ovarian cancer.…”

“…Paclitaxel is used not only in the management of breast cancer, but also other cancers, such as lung and ovary[11-15]. Cutaneous adverse effects of paclitaxel (and nab-paclitaxel) include alopecia, erythema multiforme, hand-foot syndrome (acral erythema), hypersensitivity reaction, mucositis, nail changes, photosensitivity reactions, and subacute lupus erythematosus[15-22].…”

Persistent docetaxel-induced supravenous erythematous eruption

“…These drugs act stabilizing the microtubules of mitosis, preventing breakdown and leading to cell death. 1 The antineoplastic drugs are classified according to the aggressive potential of blood vessels and adjacent tissues. They may be irritating or vesicant.…”

“…These reactions may alter the quality of life of the patients, therefore relief for the symptoms and prevention of reactions are essential. 1 We report 2 cases of cutaneous reaction to docetaxel (DCX), with the objective of familiarizing dermatologists with the side effects of chemotherapy with taxanes and advise them about the conduct to be adopted.…”

Prevalence of dermatological complaints in patients undergoing treatment for breast cancer

“… 7 Despite the lack of exact numbers, since there are no epidemiological studies of these drugs used separately, an incidence of 65% is estimated related to their use. 8 Among the most frequent are alopecia, hypersensitivity reactions and nail changes. 9 …”