Successful desensitization with temozolomide

Ruiz-García, M.; Gozalo, Manuel de las Heras; Barrera, Elena Hernandez Garcia de la; Domínguez, Jorge

doi:10.1016/j.anai.2011.02.009

Cited by 6 publications

(4 citation statements)

References 3 publications

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“…Unfortunately, there are no diagnostic tests useful in the case of TEN and in vivo tests must be made with caution. In our case, the serious situation of the patient motivated us to search for the causative drug by skin tests, but they were not useful (as in other publications4). …”

Section: Discussionmentioning

confidence: 74%

“…Hypersensitivity reactions (as erythema multiforme, erythroderma, urticaria, exantema, anaphylaxis, and angioedema) have been rarely described with temozolomide 1,4,5. In the literature, we have found one case of Stevens-Johnson syndrome (SJS) and TEN overlap in a patient treated with oral temozolomide, cranial radiotherapy, diclofenac and phenytoin,6 and other case of TEN in a patient treated with the same drugs excepting diclofenac 7.…”

Section: Discussionmentioning

confidence: 99%

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Toxic Epidermal Necrolysis in Polymedicated Patient Treated With Radiotherapy

Pérez-Calderón

Gonzalo-Garijo

Corrales-Vargas

et al. 2015

Allergy Asthma Immunol Res

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Temozolomide is an oral alkylating agent indicated for the treatment of patients with glioblastoma multiforme concomitantly with radiotherapy and subsequently as monotherapy treatment. We report the case of a patient who developed toxic epidermal necrolysis (TEN) while she was being treated with chemoradiotherapy and several drugs. Cutaneous tests were performed with the drugs involved with negative result. Although the occurrence of TEN contraindicates suspected drug readministration, we based the decision to perform the controlled administration of temozolomide on the following reasons: (1) the poor prognosis of the underlying disease, (2) the lack of therapeutic alternatives, (3) the suspicion that other drugs taken by the patient simultaneously may be responsible (as anticonvulsants and trimethoprim sulfamethoxazole [TMP-SMX]), and (4) temozolomide was the first choice for treating the patient's disease. The administration of a cumulative dose of 60 mg of temozolomide caused a slight skin reaction. Given this result, we conducted controlled administration of other drugs involved. Dexamethasone, codeine, omeprazole and levetiracetam were well tolerated. However, TMP-SMX produced a similar reaction to that caused by temozolomide. In conclusion, we present the first case of TEN induced by temozolomide and TMP-SMX associated with cranial radiotherapy confirmed by controlled administration. Radiotherapy in combination with these drugs could have favored TEN, as some authors have postulated, but we cannot prove this.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Toxic Epidermal Necrolysis in Polymedicated Patient Treated With Radiotherapy

Pérez-Calderón

Gonzalo-Garijo

Corrales-Vargas

et al. 2015

Allergy Asthma Immunol Res

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“…Desensitization therapy has been successfully utilized in several cases of delayed reactions to temozolomide where there are no therapeutic alternative treatment options. 6,7 We present a unique case of DIHS secondary to temozolomide in a patient with glioblastoma multiforme to highlight a rare cause of the syndrome. We also use this case to draw attention to the temporal relationship of drug eruptions among medications to aid in search of causality.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have described the use of de-sensitization to overcome this challenge. 6,7 We present a 54-year-old man with glioblastoma multiforme who presented with a fever, diarrhea and progressively worsening rash 6 weeks after starting temozolomide.…”

Section: Introductionmentioning

confidence: 99%

Drug-induced hypersensitivity syndrome following temozolimide for glioblastoma multiforme and the role of desensitization therapy

Ambur

Khan

et al. 2021

J Oncol Pharm Pract

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Introduction Temozolomide is an oral alkylating agent used as first line treatment of glioblastoma multiforme (GBM). It has also been used in the treatment of certain solid tumors such as metastatic melanoma. Commonly reported adverse effects include nausea and vomiting, constipation, headache, fatigue and myelosuppression. Cutaneous hypersensitivity reactions are rare and include an urticarial hypersensitivity reaction, alopecia, and Stevens–Johnson syndrome. To our knowledge, there are minimal reports of temozolomide-induced DRESS syndrome. Case Report We present a 54-year-old man with glioblastoma multiforme who presented with a fever, diarrhea and progressively worsening rash 6 weeks after starting temozolomide. Management & Outcome The patient was diagnosed recurrent DRESS syndrome and restarted on a gradual prednisone taper with resolution over the following weeks. Unfortunately, the patient was unable to be followed long-term due to relocation to a different state. Discussion To our knowledge, there are minimal reports of temozolomide-induced DRESS syndrome. The diagnosis can be life-threatening, which makes management of patients with GBM and no alternative treatment option challenging. The use of de-sensitization therapy to temozolomide has been proposed for the management of severe adverse cutaneous reactions.

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