Erlotinib
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Skin disorders (first report for Stevens-Johnson syndrome): 15 case reports A retrospective study identified four men and eleven women, aged between 52 and 93 years, who developed skin disorders during treatment with erlotinib for lung or pancreatic cancer. The patients developed skin disorders after 3–180 days of treatment with erlotinib 50–150 mg/day [routes not stated; time to onset not stated for one patient]. Skin reactions included papulopustular eruptions in 12 patients, with combined papulopustular lesions and excema and/or xerosis in ten of these, and eczematous plaques and patches in three patients. Analysis of a skin biopsy from one patient revealed findings consistent with a drug reaction. Three patients experienced nail abnormalities, such as paronychia and brittle nails, and one patient had mild alopecia. One patient, a 68-year-old man, experienced worsening lesions after his erlotinib dosage was increased from 125 to 150 mg/day. Treatment comprised antibiotics, topical steroids and local care with emollients and anti-pruritic treatment. Within 3 months, skin lesions completely resolved in seven patients, and improved in six; erlotinib was continued in all of these patients. One patient was lost to follow up, and lesions only improved after erlotinib cessation in the previously mentioned 68-year-old man. In this patient, skin eruptions recurred after erlotinib was restarted, the man became neutropenic, developed a Herpes zoster infection and ultimately presented with Stevens-Johnson syndrome. He was hospitalised, erlotinib was again discontinued, and his skin lesions improved. He again decided to restart erlotinib, but his skin reaction recurred and the drug was permanently discontinued. Wnorowski AM, et al. The management of EGFR inhibitor adverse events: A case series and treatment paradigm. International Journal of Dermatology 51: 223-232, No. 2, Feb 2012. Available from: URL: http://dx.doi.org/10.1111/ 803068656 j.1365-4632.2011.05082.x - USA
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of StevensJohnson syndrome associated with erlotinib. The WHO ADR database contained eight reports of Stevens-Johnson syndrome associated with erlotinib.
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Reactions 31 Mar 2012 No. 1395
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