Toxic Epidermal Necrolysis Related to Cisplatin and Pemetrexed for Metastatic Non-Small Cell Lung Cancer

Abstract

Background: Toxic epidermal necrolysis (TEN) is an uncommon but life-threatening adverse drug reaction. Pemetrexed is a multitargeted antifolate. It was first used in combination with cisplatin as a front-line treatment for malignant pleural mesothelioma. The same combination is nowadays approved in the first-line setting for locally advanced or metastatic nonsquamous non-small cell lung cancer (NSCLC). Patient and Methods: We report the case of a 50-year-old man treated for metastatic NSCLC. Within 5 days after administration of the second cycle of cisplatin and pemetrexed, he developed large blisters, which secondarily became hemorrhagic, and mucosal lesions. The characteristic clinical appearance, the histopathological findings, and the clinical course were decisive for the diagnosis of TEN. Treatment with systemic steroids and intravenous antibiotics as well as topical wound treatment led to resolution and improvement of his general condition. Conclusions: To the best of our knowledge, this is the third case of TEN due to pemetrexed in a patient with NSCLC. Clinicians should be aware of TEN as a rare but potentially fatal disorder requiring hospitalization and multidisciplinary management.

A case report of toxic epidermal necrolysis associated with AZD-9291

“…Although skin toxicity is a well-known side effect of pemetrexed and there have been some reports of TEN induced by pemetrexed plus cisplatin treatment, 17 , 18 we have not suspected pemetrexed plus cisplatin treatment as the cause of this case of TEN, because of the onset time of the disease. TEN usually occurs between 7 and 28 days after the initial drug administration, but the patient successfully completed the chemotherapy for six cycles (21 days every cycle) without skin toxicity, which implies that the chemotherapy has nothing to do with the case of TEN.…”

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

“…Tummino et al [6] reported on the appearance of a TEN-like reaction 15 days after administration of the second cycle of pemetrexed given for a refractory non-mall cell lung cancer. Another case of a TEN-like reaction including mucosal lesions and haemorrhagic blisters was noticed after the second cycle of pemetrexed and cisplatin given for metastatic non-small cell lung cancer [7]. Bosch-Barrera et al [3] described a case of a TEN-like reaction after the second cycle of pemetrexed, given in conjunction with carboplatin and Vitamin B12 and folic acid supplementation.…”

Icotinib and pemetrexed in treatment of lung adenocarcinoma and the effects on prognostic survival rate of patients

“…Currently, clinical studies have shown that pemetrexed can significantly prolong the survival time of adenocarcinoma patients and better control progressive disease (23). However, the incidence of its toxic and side effects such as myelosuppression (leukopenia, neutropenia and thrombocytopenia) and gastrointestinal reactions is high, therefore it is difficult to achieve the desired efficacy (24). Long-term pemetrexed combination treatment still has high requirements for patients' physical quality, but there are extremely few studies on the efficacy comparison between icotinib and pemetrexed in clinical practice.…”