Husein et al reported the onset of severe Raynaud syndrome induced by adjuvant interferon alpha in a woman who underwent surgery for cutaneous ulcerated nodular melanoma, with evolution to pelvic limphonodal methastasis. This patient was suffering from a previously undiagnosed sclerodermia. We report here a similar experience in a woman suffering from adenocarcinoma of the lung, who developed upper limb digital necrosis after the start of second line treatment with erlotinib, an oral anticancer drug that inhibits the epidermal growth factor receptor (EGFR). Our case deals with a 72 year-old, non smoker, hypertensive woman, affected with metastatic lung cancer on progression even after three cycles of chemotherapy with carboplatin and gemcitabine. Fourtheen days after the start of erlotinib, at the orally dosage of 150 mg/die, she presented to our visit for the onset of a digital necrosis at the second finger of right hand. Erlotinib was promptly discontinued, and treatment with calcium-channel blockers, nitrates, and antiplatelet drugs was initiated. After three weeks of therapy, the digital lesion was completely healed. Similarly to the patient described by Husein et al, our patient had an unrecognized sclerodermia as well. In fact, her medical history included Raynaud phenomenon, physical examination showed acrosclerosis and teleangiectasia, and anti-Scl-70 antibodies were positive. According to the Naranjo adverse drug reaction algorhythm, the total score was 7 (0: doubtful; 1-4: possible; 5-8: probable; 9: highly probable), and the hypothesis of cause-effect relationship is so plausible. At the best of our knowledge, this is the first report of onset of digital ulcers after erlotinib therapy. Therefore, we believe that the possible presence of Raynaud phenomenon, associated or not with sclerodermia, should be carefully investigated prior to start anti-cancer therapy, to avoid onset of vascular ischemic disease with digital necrosis. In any case, this kind of complication should be always considered, in the view of a prompt intervention at first clinical signs. This recommendation is valid not only for biologic drus, but for chemiotherapic drugs as well. Recently, the use of tyrosine kinase inhibitors has been proposed for treatment of systemic sclerosis and fibrotic diseases, due to their potential anti-fibrotic effects. We believe that, in patients with sistemic sclerosis and/or Raynaud phenomenon, the utilization of such drugs should deserve prior extremely careful evaluation.
Digital necrosis induced by erlotinib treatment in metastatic adenocarcinoma of the lung
MANFREDINI, Roberto
2011
Abstract
Husein et al reported the onset of severe Raynaud syndrome induced by adjuvant interferon alpha in a woman who underwent surgery for cutaneous ulcerated nodular melanoma, with evolution to pelvic limphonodal methastasis. This patient was suffering from a previously undiagnosed sclerodermia. We report here a similar experience in a woman suffering from adenocarcinoma of the lung, who developed upper limb digital necrosis after the start of second line treatment with erlotinib, an oral anticancer drug that inhibits the epidermal growth factor receptor (EGFR). Our case deals with a 72 year-old, non smoker, hypertensive woman, affected with metastatic lung cancer on progression even after three cycles of chemotherapy with carboplatin and gemcitabine. Fourtheen days after the start of erlotinib, at the orally dosage of 150 mg/die, she presented to our visit for the onset of a digital necrosis at the second finger of right hand. Erlotinib was promptly discontinued, and treatment with calcium-channel blockers, nitrates, and antiplatelet drugs was initiated. After three weeks of therapy, the digital lesion was completely healed. Similarly to the patient described by Husein et al, our patient had an unrecognized sclerodermia as well. In fact, her medical history included Raynaud phenomenon, physical examination showed acrosclerosis and teleangiectasia, and anti-Scl-70 antibodies were positive. According to the Naranjo adverse drug reaction algorhythm, the total score was 7 (0: doubtful; 1-4: possible; 5-8: probable; 9: highly probable), and the hypothesis of cause-effect relationship is so plausible. At the best of our knowledge, this is the first report of onset of digital ulcers after erlotinib therapy. Therefore, we believe that the possible presence of Raynaud phenomenon, associated or not with sclerodermia, should be carefully investigated prior to start anti-cancer therapy, to avoid onset of vascular ischemic disease with digital necrosis. In any case, this kind of complication should be always considered, in the view of a prompt intervention at first clinical signs. This recommendation is valid not only for biologic drus, but for chemiotherapic drugs as well. Recently, the use of tyrosine kinase inhibitors has been proposed for treatment of systemic sclerosis and fibrotic diseases, due to their potential anti-fibrotic effects. We believe that, in patients with sistemic sclerosis and/or Raynaud phenomenon, the utilization of such drugs should deserve prior extremely careful evaluation.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
