Gefitinib-induced acute generalized exanthematous pustulosis in two patients with advanced non-small-cell lung cancer

Hc, Shih; Yp, Hsiao; Wu, Ming-Fang; Jh, Yang

doi:10.1111/j.1365-2133.2006.07511.x

Cited by 9 publications

(9 citation statements)

References 9 publications

(17 reference statements)

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“…In our search, 11 cases of AGEP caused by imatinib (n=4), sorafenib (n=3), gefitinib (n=2), vemurafenib (n=1), and ipilimumab (n=1) were identified. 88 – 91 AGEP usually presents as pinhead-sized “nonfollicular” pustules on an erythematous base, starting mainly on the fold area (axillary, inguinal, and submammary) and spreading quickly to the trunk and limbs with further characteristic large-sheet collaret desquamation. 92 AGEP should be differentiated from the common acneiform papulopustular eruptions caused by EGFR inhibitors.…”

Section: Acute Generalized Exanthematous Pustulosismentioning

confidence: 99%

Severe cutaneous adverse reactions induced by targeted anticancer therapies and immunotherapies

Chen¹,

Wu²,

Ng³

et al. 2018

CMAR

123

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With the increasing use of targeted anticancer drugs and immunotherapies, there have been a substantial number of reports concerning life-threatening severe cutaneous adverse reactions (SCARs), including Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms, drug-induced hypersensitivity syndrome, and acute generalized exanthematous pustulosis. Although the potential risks and characteristics for targeted anticancer agent- and immunotherapy-induced SCAR were not well understood, these serious adverse reactions usually result in morbidity and sequela. As a treatment guideline for this devastating condition is still unavailable, prompt withdrawal of causative drugs is believed to be a priority of patient management. In this review, we outline distinct types of SCARs caused by targeted anticancer therapies and immunotherapies. Also, we discuss the clinical course, latency, concomitant medication, tolerability of rechallenge or alternatives, tumor response, and mortality associated with these devastating conditions. Imatinib, vemurafenib, and rituximab were the top three offending medications that most commonly caused SJS/TEN, while EGFR inhibitors were the group of drugs that most frequently induced SJS/TEN. For drug rash with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome and acute generalized exanthematous pustulosis, imatinib was also the most common offending drug. Additionally, we delineated 10 SCAR cases related to innovative immunotherapies, including PD1 and CTLA4 inhibitors. There was a wide range of latency periods: 5.5–91 days (median). Only eight of 16 reported patients with SCAR showed clinical responses. Targeted anticancer drugs and immunotherapies can lead to lethal SCAR (14 deceased patients were identified as suffering from SJS/TEN). The mortality rate of TEN was high: up to 52.4%. The information compiled herein will serve as a solid foundation to formulate ideas for early recognition of SCAR and to discontinue offending drugs for better management.

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Section: Acute Generalized Exanthematous Pustulosismentioning

confidence: 99%

Severe cutaneous adverse reactions induced by targeted anticancer therapies and immunotherapies

Chen¹,

Wu²,

Ng³

et al. 2018

CMAR

123

View full text Add to dashboard Cite

show abstract

“…In the literature, the AGEP case-fatality rate has been suggested to be 2-5%, which is often due to multi-organ failure or secondary infections [3,4,12,13]. The 7 out of 297 patients in this case series whose death was reported and collected [75,91,104,132,151,182,221] would yield a similar case-fatality rate of 2.4%. However, disentangling the cause of death in these patients is challenging.…”

Section: Discussionmentioning

confidence: 79%

“…In the study cohort, seven deaths were recorded [75,91,104,132,151,182,221]. A summary description of the patients with a fatal outcome is included in Table 2.…”

Section: Resultsmentioning

confidence: 99%

Drug Triggers and Clinic of Acute Generalized Exanthematous Pustulosis (AGEP): A Literature Case Series of 297 Patients

Vallejo-Yagüe

Torre

Mohamad

et al. 2022

JCM

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Acute generalized exanthematous pustulosis (AGEP) is a rare skin reaction, commonly caused by drugs. Available evidence mostly relies on small studies or case reports. We collected published AGEP case reports and, subsequently, described the patient characteristics, suspect and concomitant drugs, time to onset, disease management, and clinical prognosis. This study included 297 AGEP patients (64.3% women) obtained from 250 published case reports or case series with individual patient data. AGEP affected patients of all ages, but the majority of patients (88.2%) were ≥25 years old. The most frequently reported suspect drugs were anti-infectives for systemic use (36.5%), particularly antibacterials for systemic use (31.0%), and especially beta-lactam antibacterials (18.3%) and macrolides (4.3%). Other frequent suspect drugs were antineoplastics (12.2%), and anti-inflammatory/anti-rheumatic products (5.2%) plus hydroxychloroquine (12.8%). Mean time to onset was 9.1 days (standard deviation SD 13.94). Some patients developed fever (64.3%) and systemic involvement (18.9%), and most patients (76.4%) received pharmacological treatment for AGEP. Seven patients died, although five of them were already critically ill prior to AGEP. In conclusion, antibiotics remain the most common suspected cause of AGEP. While case mortality rate may be up to 2.5%, disentangling the role of AGEP on the fatal outcome from the role of the preexisting health conditions remains challenging.

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“…7 The eruption reported herein differs from AGEP by the absence of fever and different course and distribution. A bacterial superinfection could be excluded by the absence of bacterial clumps in the stratum corneum and negative findings from special stains in histologic examinations.…”

mentioning

confidence: 68%

Severe Purpuric Xerotic Dermatitis Associated With Gefitinib Therapy

Sheen¹,

Hsiao²,

Chu³

2008

Arch Dermatol

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Gefitinib-induced acute generalized exanthematous pustulosis in two patients with advanced non-small-cell lung cancer

Cited by 9 publications

References 9 publications

Severe cutaneous adverse reactions induced by targeted anticancer therapies and immunotherapies

Severe cutaneous adverse reactions induced by targeted anticancer therapies and immunotherapies

Drug Triggers and Clinic of Acute Generalized Exanthematous Pustulosis (AGEP): A Literature Case Series of 297 Patients

Severe Purpuric Xerotic Dermatitis Associated With Gefitinib Therapy

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