Ribociclib-Related Stevens–Johnson Syndrome: Oncologic Awareness, Case Report, and Literature Review

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis belong to a severe dermatopathic spectrum that includes frequently fatal mucocutaneous manifestations consisting of whole epidermal necrosis and sloughing with bullous transformation, blistering, and further skin detachment. Notably, cancer patients are at higher risk of developing SJS than the general population as a consequence of both the nature of neoplastic disease and frequent exposure to anticancer drugs. Ribociclib is a newly approved cycline-dependent kinase inhibitor that has been recently associated with a single case of SJS. We hereby present a case of ribociclib-related SJS. Early detection of threatening skin lesions is crucial to permit the immediate discontinuation of ribociclib given the predictable and unacceptable risk level. In cases of established SJS, early aggressive support should be initiated, ribociclib should be abruptly discontinued, and specific treatment based on actual evidence should be started.

Hypersensitivity Reactions to Cancer Chemotherapy: Practical Recommendations of ARADyAL for Diagnosis and Desensitization

“…The incidence of DHRs to PKIs is unknown and some cases of IDHRs, such as urticaria and angioedema [58][59][60][61], as well as NIDHR, have been reported. The most frequent NIDHR are MPE and non-immediate urticaria [62][63][64], although some cases of SJS induced by regorafenib (inhibitor of vascular endothelial growth factor receptor [VEGFR]), ribociclib and palbociclib (inhibitors of cyclin-dependent protein kinases [DCK]) have been described [65,66].…”

Diverse landscape of dermatologic toxicities from small‐molecule inhibitor cancer therapy

“…[181][182][183][184][185][186][187][188][189] There are rare reported cases (although more than with other Nibs) of blistering dermatitis (9%), including bullous pemphigoid. 190,191 Cases of discoid or subacute chronic lupus, [192][193][194][195] ashy dermatosis (erythema dyschromicum perstans), 196 leukocytoclastic vasculitis, 197 and SJS [198][199][200][201] have also been reported with CDK4/6 inhibitors. $20% to 80%-90%, making CML the first cancer to strongly respond to targeted anticancer therapy.…”

Ribociclib-Induced Erythema Dyschromicum Perstans (Ashy Dermatosis)–Like Pigmentation in a Metastatic Breast Cancer Patient

“…Cutaneous and gastrointestinal leukocytoclastic vasculitis, subacute cutaneous lupus erythematosus, Stevens–Johnson syndrome, and toxic epidermal necrolysis induced by the CDK 4/6 inhibitor palbociclib have also been described [ 4 5 6 ]. Enhanced dermatologic toxicity has been reported following concurrent treatment with palbociclib and radiation therapy [ 7 ].…”

“…The main dermatological adverse events associated with CDK 4/6 inhibitors that have been described in the literature include skin rash, an increased risk of alopecia, and stomatitis [ 3 4 5 6 7 ].…”