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Treatment for non-small cell lung cancer causes rare cutaneous eruptions
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Patients with non-small cell lung cancer treated with epidermal growth factor receptor inhibitors rarely experienced purpuric skin lesions, which had characteristic clinical and histopathologic presentations, according to study results recently published in JAMA Dermatology.
Researchers in Taiwan conducted a prospective study of 32 patients who presented with purpuric skin lesions after using epidermal growth factor (EGFR) receptor tyronise kinase inhibitors (TKIs) for non-small cell lung cancer between 2013 and 2015 at a tertiary referral medical center. A total of 3,350 patients had received the treatment at the center during the study period.
Fourteen patients (mean age, 60 years; 12 women) experienced purpuric drug eruptions without pustules and 18 patients (mean age, 64 years; 12 women) experienced purpuric drug eruptions with pustules, with a median time of 3.5 months to development of skin lesions.
Purpuric macules and papules with confluent plaques were predominantly on the lower extremities.
Eighteen patients had nonfollicular pustules of various sizes, while 13 patients had changes in lesions that mimicked eczema craquelé.
All patients with pustules had Staphylococcus aureus identified, compared with two patients without pustules (P < .001).
Histopathologic features included epidermal dysmaturation, neutrophil exocytosis, perivascular infiltration of lymphocytes and neutrophils, red blood cell extravasation and plumping endolethium. Lesional skin showed a marked reduction in expressions of filaggrin and human beta-defensin 2.
All patients received systemic first-generation cephalosporin antibiotics for at least 1 week. Fourteen patients had dosages of EGFR TKIs adjusted by their oncologists, including three patients who had reduced dosages and 11 patients ceased EGFR TKI treatment until the cutaneious lesions improved and then resumed treatment.
“The present study reports an uncommon cutaneous adverse reaction caused by EGFR TKIs,” the researchers concluded. “Treatments with systemic antibiotics usually results in improvements. Additional studies are needed to explore the details of the pathomechanisms of [purpuric drug eruptions].” – by Bruce Thiel
Disclosure: Cho reports being a consultant and speaker for Boehringer Ingelheim International GmbH and being a consultant for Novartis. The other researchers report no relevant financial disclosures.
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