Pemetrexed-induced painful erythematous nodules in both legs in a patient with recurrent mesothelioma

Our plain-English summary of Pemetrexed-induced painful erythematous nodules in both legs in a patient with recurrent mesothelioma, by M. Llamas-Velasco, E. Ovejero-Merino, J. Fraga, et al (Journal of Cutaneous Pathology, 2018).

The study

• Authors: M. Llamas-Velasco, E. Ovejero-Merino, J. Fraga, A. García-Diez, R. Moreno-Balsalobre
• Journal: Journal of Cutaneous Pathology
• Published: 2018;45(2):184-186
• Type of article: Case report, Letter
• Read it: PubMed · Publisher

In plain English

This letter to the editor was a case report about one patient, from Hospital Universitario de La Princesa in Madrid, Spain. A 50-year-old woman had malignant pleural mesothelioma diagnosed in 2003 and treated with surgery and chemotherapy. In 2011 a biopsy confirmed the mesothelioma had come back. After radiotherapy, she received the cancer drug pemetrexed every 21 days. Forty-eight hours after the third cycle, painful nodules and red plaques appeared on her legs. Doctors first suspected panniculitis, an inflammation of the fat under the skin. A skin biopsy ruled out involvement of the fat tissue and showed changes in the skin's outer layers, and skin cultures were negative. The lesions came back a few hours to 36 hours after later cycles and were controlled with steroid creams applied to the skin. The authors wrote that these findings supported considering the reaction a drug-induced hypersensitivity. They reported her as the first patient described with such lesions while receiving pemetrexed for mesothelioma, adding a nodular form to the known skin reactions to this drug. The article did not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (letter to the editor)
• Who was studied: One 50-year-old woman with malignant pleural mesothelioma diagnosed in 2003 and found to have recurred in April 2011, seen at Hospital Universitario de La Princesa, Madrid, Spain
• Exposure: The exposure studied was the chemotherapy drug pemetrexed, given intravenously every 21 days as third-line treatment after radiotherapy (up to 60 Gy). Asbestos exposure is not described in the article.
• Main results:
  • The patient developed new skin lesions 48 hours after her third cycle of pemetrexed.
  • Examination showed several painful nodules and red plaques on the lower legs.
  • The skin biopsy ruled out involvement of the fat tissue. It showed hyperkeratosis, epidermal dysmaturation and slight vacuolar degeneration of the basal layer. Skin cultures were negative.
  • The lesions recurred from a few hours to 36 hours after every cycle for the next 3 (a word appears to be missing in the text). These episodes were well controlled with topical corticosteroids.
  • The authors observed a resemblance to fixed drug reaction: the lesions worsened after every infusion, and postinflammatory hyperpigmentation remained after they resolved.
  • The authors stated that this type of reaction had previously been reported only in patients with non-small cell lung cancer. They described their patient as the first reported with such lesions while receiving pemetrexed for mesothelioma.
• The authors' conclusion: The authors wrote that the findings support considering this adverse event a drug-induced hypersensitivity. They stated that the nodular presentation, not previously reported to their knowledge, expands the spectrum of pemetrexed-induced skin lesions.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pemetrexed (Alimta), Mesothelioma.

Related studies

• Pemetrexed-induced scleroderma-like conditions in the lower legs of a patient with non-small cell lung carcinoma — K. Ishikawa, T. Sakai, et al. (2016)
• Single-dose dexamethasone for the prevention of pemetrexed associated cutaneous adverse reactions — R. Elsoueidi, M.J. Lander, et al. (2016)
• Pemetrexed induced acute kidney injury in patients with non-small cell lung cancer: reversible and chronic renal damage — G. Rombolà, F. Vaira, et al. (2015)
• Nintedanib in combination with pemetrexed and cisplatin for chemotherapy-naive patients with advanced malignant pleural mesothelioma (LUME-Meso): a double-blind, randomised, placebo-controlled phase 3 trial — G.V. Scagliotti, R. Gaafar, et al. (2019)
• Pemetrexed induces apoptosis in malignant mesothelioma and lung cancer cells through activation of reactive oxygen species and inhibition of sirtuin 1 — K.E. Hwang, Y.S. Kim, et al. (2015)
• A phase Ib study of GSK3052230, an FGF ligand trap in combination with pemetrexed and cisplatin in patients with malignant pleural mesothelioma — E.M.J. van Brummelen, E. Levchenko, et al. (2020)

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