Docetaxel (Taxotere) associated scleroderma-like changes of the lower extremities. A report of three cases

Abstract

Background. Docetaxel (Taxotere) is a microtubule‐stabilizing agent that is potentially important in chemotherapy for a variety of malignancies. Methods. A clinical study of the cutaneous reactions experienced by a group of patients receiving docetaxel chemotherapy was undertaken. Patients were examined before initiation of therapy, before and after each cycle of therapy, and were followed subsequent to the completion of docetaxel chemotherapy. Results. Three patients developed diffuse lower extremity edema (3‐18 kg) and subsequent scleroderma‐like changes after receiving multiple cycles of docetaxel therapy. These patients had different underlying malignancies and dissimilar prior therapy. Rheumatoid factor, antinuclear antibodies, anticentromere, and topoisomerase antibodies were not present in any patient. The diffuse lower extremity edema did not resolve with diuretic therapy. Cutaneous biopsies in two patients revealed diffuse sclerosis. One patient had a normal lymphangiogram during the edematous phase. Discontinuation of docetaxel correlated with resolution of edema and softening of the skin. Conclusion. The etiology of the scleroderma‐like skin changes is unclear but appears to be either a toxic effect of docetaxel or an effect of polysorbate 80 (Tween 80), the vehicle for docetaxel.

Paclitaxel-Related Lymphedema and Scleroderma-Like Skin Changes

“…Histology evidenced scleroderma-like changes but no biological features of systemic scleroderma were observed. Resolution of both the edema and the cutaneous alterations was observed after the discontinuation of docetaxel [1]. Scleroderma-like cutaneous changes have already been reported after exposure to various organic solvents (polyvinyl chloride, benzene, toluene), drugs (bleomycin, carbidopa, pentazocine, isoniazid, valproic acid, bromocriptine, nitrofurantoin, penicillamine, diltiazem, fosinopril, cocaine) and miscellaneous substances (rapeseed oil/aniline, silicon dioxide, L-tryptophan, taxanes, topotecan) [17].…”

“…Scleroderma-like skin changes were first reported in patients treated by docetaxel who developed a lower limbs or a generalized edema followed by a thickening of the skin [1]. Histology evidenced scleroderma-like changes but no biological features of systemic scleroderma were observed.…”

“…Scleroderma-like changes have been exceptionally reported. Up to date, twenty-one cases have been reported with docetaxel [1][2][3][4][5][6] and thirteen with paclitaxel [5,[7][8][9][10][11][12][13][14][15][16]. Two cases suggest an, at least partial, pathogenic role of paclitaxel-induced scleroderma in the subsequent development of severe lymphedema without mechanical or tumor obstruction of the lymph vessels.…”

Recall-Dermatitis durch Docetaxel-Reexposition nach Gehirnbestrahlung Fallbeobachtung und Literaturübersicht

“…Rubin et al [26] Extremitäten lokalisiert wurde beschrieben [1]. Zunächst entsteht ein Ödem, anschließend eine Induration, die sich nach Therapieende innerhalb 1 Jahres zurückbildet.…”

“…zum Abbruch der zytostatischen Behandlung führten. Erythematöse Veränderungen traten bei 60-70% der Patienten auf[1,13,15,21,34]. Die maximale Ausprägung des Erythems zeigte sich 2-4 Tage nach Gabe von Docetaxel.…”