Severe cutaneous toxicity after Pemetrexed as second line treatment for a refractory non small cell lung cancer

May 24, 2007

Revue des Maladies Respiratoires. 2007 May;24(5):635-8. [Link]

C. Tummino[1], F. Barlesi[1], C. Tchouhadjian[1], A.M. Tasei[2],
C. Gaudy-Marqueste[3], M.A. Richard[3], P. Astoul[1]

  • [1] Faculté de Médecine, Université de la Méditerranée-Assistance Publique Hôpitaux de Marseille, Service d’Oncologie Thoracique, Hôpital Sainte-Marguerite, Marseille, France.
  • [2] Faculté de Médecine, Université de la Méditerranée-Assistance Publique Hôpitaux de Marseille, Service d’Anatomopathologie, Hôpital Sainte-Marguerite, Marseille, France.
  • [3] Faculté de Médecine, Université de la Méditerranée-Assistance Publique Hôpitaux de Marseille, Service de Dermatologie et Vénéréologie, Hôpital Sainte-Marguerite, Marseille, France.

Abstract

Introduction: Pemetrexed is a chemotherapeutic drug with good tolerance, used as first line treatment for malignant pleural mesothelioma in association with cisplatin, and alone as second line treatment in resistant or relapsing non-small cell lung cancer (NSCLC). However, cutaneous toxicity has been described, principally as a rash. Cutaneous toxicity of all grades has been observed in up to 14%, and grade 3 or 4 toxicity in 0.8-1.3% of cases.

Case report: We report the case of an 85 year old man treated for NSCLC presenting 15 days after administration of the second cycle of pemetrexid with cutaneous lesions including erythema, bullae, and desquamation, associated with deterioration in his general condition; a skin reaction corresponding to Lyell’s syndrome. Treatment with steroids and gammaglobulins led to local resolution and improvement in his general condition.

Conclusion: Cutaneous toxicity from pemetrexed should be recognised on account of its potential severity. The appearance of skin lesions is an indication for careful follow-up for evidence of Lyell’s syndrome for which intensive management is needed.

Keywords: Pemetrexed, Non-small cell lung cancer, Toxic epidermal necrolysis, Lyell’s syndrome, Drug monitoring, Gamma-globulins

Posted in Case Study, Chemotherapy, Full Archive, Pemetrexed (Alimta), Treatment, Type of Assessment: