Toxic epidermal necrolysis related to AP (pemetrexed plus cisplatin) and gefitinib combination therapy in a patient with metastatic non-small cell lung cancer

Abstract

Toxic epidermal necrolysis (TEN) is a rare acute life-threatening mucocutaneous disorder that is mostly drug-related (80%-95%). It is clinically characterized as a widespread sloughing of the skin and mucosa. AP regimen (pemetrexed plus cisplatin) has been the preferred first-line chemotherapy for metastatic non-squamous non-small cell lung cancer (NSCLC). Gefitinib, a small-molecule epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), has already been recommended as a first-line treatment in EGFR-mutant metastatic NSCLC. We report rare presentation of TEN involving adverse effects of AP and gefitinib combination treatment in a 42-year-old woman diagnosed with metastatic NSCLC harboring an EGFR mutation. On the 21st day after administration of the first cycle of AP regimen and the 8th day after the initiation of gefitinib treatment, she developed an acne-like rash, oral ulcer, and conjunctivitis, which later became blisters and ultimately denuded. The characteristic clinical courses were decisive for the diagnosis of TEN. Treatment with systemic steroids and immunoglobulin as well as supportive treatment led to an improvement of her general condition and a remarkable recovery.

Slowly developing toxic epidermal necrolysis-like reaction associated with pemetrexed and carboplatin

“…A case of pemetrexed and carboplatin-associated TEN-like reaction in a patient with non-small cell lung cancer and pre-existing Sharp syndrome occurring primarily in the previous radiation field was reported by Then et al [8]. Another case of a TEN-like reaction in association with pemetrexed and cisplatin, given in combination with gefitinib, manifesting after the first cycle was described by Huang et al [9]. All of these cases described a rapid progression of the TEN-like reaction and none of the reported TEN-like reactions had a fatal outcome.…”

Stevens‐Johnson syndrome/toxic epidermal necrolysis overlap in a NSCLC patient treated with afatinib

“…Afatinib hat ein genau definiertes Sicherheitsprofi l; zu den häufi gsten Nebenwirkun-gen gehören Durchfall, Hautausschlag, Akne, Mukositis und Paronychie [2,3]. Ein weiterer Bericht beschrieb das Auftreten von TEN bei einem NSCLC-Patienten, der mit Gefi tinib, einem EGFR-TKI der ersten Generation, und Pemetrexed behandelt wurde [11]. Ein weiterer Bericht beschrieb das Auftreten von TEN bei einem NSCLC-Patienten, der mit Gefi tinib, einem EGFR-TKI der ersten Generation, und Pemetrexed behandelt wurde [11].…”

Dermatologic adverse events associated with chemotherapy and targeted anticancer therapy

“…Znaczenie badania histopatologicznego polega na możliwości wyłączenia innych chorób pęcherzowych, takich jak pęcherzyca, pemfigoid, linijna dermatoza IgA, pęcherzyca paraneoplastyczna [52,53]. Wśród przyczyn SJS i TEN należy rozpatrywać zakażenia wirusowe i bakteryjne, głównie jednak stosowane leki.…”