Bullous Skin Rash: A Rare Case of Palbociclib-Induced Dermatological Toxicity

Abstract

Palbociclib is an FDA-approved cyclin-dependent kinase inhibitor to treat hormone-positive, HER2-negative metastatic breast cancer. Severe skin toxicities are rare but important adverse events associated with these agents. Early detection of severe forms of skin lesions is crucial to permit the immediate discontinuation of palbociclib in order to avoid unacceptable risk level in the form of severe cutaneous toxicities like Steven-Johnson Syndrome. In such cases, palbociclib should be abruptly discontinued and an early aggressive support should be initiated. We here present a case of 50-year-old Caucasian female, who developed acute onset blistering skin lesions one to two weeks after she was started on palbociclib. We sought to report this case given the unusual toxicity and to emphasize the importance of identifying the acute onset of blistering skin lesions, regardless of their extension, should prompt awareness of their potential severity.

Mucocutaneous drug reaction after treatment with Phosphatidylinositol-3-kinase inhibitor

“…Rashes associated with alpelisib have a median onset of 13 days. 6 The acute temporality of rash onset supports the notion that alpelisib is the most likely cause of the observed exanthem.…”

Ribociclib-Induced Delayed Dermatological Reaction: Case Report of a Rare Adverse Effect and Review of Literature

“…This suggests the need for regular scheduling of patient visits in patients on CDK4/6 inhibitors, once every 4 weeks, despite the lack of significant toxicity in the initial months of treatment. Third, others have reported the benefit of topical or systemic steroid use in managing severe skin toxicities, [20][21][22] but the toxicity resolved completely in our case with discontinuation of ribociclib. This suggests that the first intervention should be withdrawal of CDK4/6 inhibitor followed by careful monitoring of skin toxicity.…”

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.…”