Toxic epidermal necrolysis related to Cisplatin and pemetrexed for metastatic non-small cell lung cancer

Our plain-English summary of Toxic epidermal necrolysis related to Cisplatin and pemetrexed for metastatic non-small cell lung cancer, by K. Scheinpflug, C. Menzel, A. Koch, et al (Onkologie, 2012).

The study

• Authors: K. Scheinpflug, C. Menzel, A. Koch, C. Kahl, H.J. Achenbach
• Journal: Onkologie
• Published: 2012;35(10):600-3
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Toxic epidermal necrolysis (TEN) is an uncommon but life-threatening adverse drug reaction. Pemetrexed is a multitargeted antifolate. It was first used in combination with cisplatin as a front-line treatment for malignant pleural mesothelioma. The same combination is nowadays approved in the first-line setting for locally advanced or metastatic nonsquamous non-small cell lung cancer (NSCLC).

Patient And Methods: We report the case of a 50-year-old man treated for metastatic NSCLC. Within 5 days after administration of the second cycle of cisplatin and pemetrexed, he developed large blisters, which secondarily became hemorrhagic, and mucosal lesions. The characteristic clinical appearance, the histopathological findings, and the clinical course were decisive for the diagnosis of TEN. Treatment with systemic steroids and intravenous antibiotics as well as topical wound treatment led to resolution and improvement of his general condition.

Conclusions: To the best of our knowledge, this is the third case of TEN due to pemetrexed in a patient with NSCLC. Clinicians should be aware of TEN as a rare but potentially fatal disorder requiring hospitalization and multidisciplinary management.

Copyright © 2012 S. Karger AG, Basel.

In plain English

This was a case report about one patient, a 50-year-old man treated in Germany for stage IV non-small cell lung cancer, a poorly differentiated adenocarcinoma with spread to the brain. The article does not concern asbestos exposure. Malignant pleural mesothelioma appears only as background, as the disease for which pemetrexed was first used. The patient received cisplatin and pemetrexed every 3 weeks. Within 5 days after the second cycle, which was given at a 20% lower dose, he developed a red rash covering 40% of his body surface and sores of the mucous membranes. Large fragile blisters followed, became bloody and ruptured. The authors based the diagnosis of toxic epidermal necrolysis (TEN), a severe drug reaction, on the clinical appearance, the skin biopsy findings and the clinical course. Cultures of the blister fluid grew Staphylococcus aureus. With intravenous steroids, antibiotics and wound care, the rash and mucosal lesions resolved within 1 week. The chemotherapy was stopped and replaced with docetaxel. The authors concluded that, to their knowledge, this was the third reported case of TEN due to pemetrexed in a patient with this type of lung cancer.

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 (single patient)
• Who was studied: One 50-year-old Caucasian man with stage IV non-small cell lung cancer (poorly differentiated adenocarcinoma, brain metastases), treated at a lung clinic in Lostau, Germany; dates of treatment not stated. He had a 26-pack-year smoking history.
• Exposure: Chemotherapy drugs, not asbestos: first-line cisplatin (75 mg/m2, day 1) and pemetrexed (500 mg/m2, day 1) every 3 weeks, with vitamin B12 and folic acid supplementation. The second cycle was given with a 20% dose reduction.
• Main results:
  • After the first course, the patient had grade 2 mucositis, weight loss of 8 kg and constipation.
  • Within 5 days after the second cycle, the patient developed a red rash covering 40% of the body surface, plus mucosal lesions.
  • The blisters became hemorrhagic (bloody) and ruptured, and sheets of dead outer skin came away.
  • The skin biopsy showed an inflammatory infiltrate around blood vessels and scattered dead skin cells. Immunofluorescence testing was negative.
  • Cultures of the blister contents grew Staphylococcus aureus.
  • The authors based the diagnosis of TEN on the clinical appearance, the histopathological findings and the clinical course.
  • Treatment consisted of intravenous dexamethasone, intravenous ampicillin/sulbactam for 7 days, and gentamicin ointment with gauze. With this treatment, the rash and mucosal lesions resolved and the patient's general condition improved within 1 week.
  • Cisplatin and pemetrexed were stopped. The patient then received 4 cycles of docetaxel at a 25% dose reduction and palliative radiotherapy to the head. A CT scan afterwards showed partial remission of the cancer.
• The authors' conclusion: The authors concluded that, to their knowledge, this was the third case of TEN due to pemetrexed in a patient with non-small cell lung cancer. They said clinicians should be aware of TEN as a rare but potentially fatal disorder requiring hospitalization and multidisciplinary management.

Topics

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

Medical terms in this study, explained in our Lexicon: Cisplatin, Pemetrexed (Alimta), Non-Small Cell Lung Cancer, Antifolate, Pleural Mesothelioma.

Related studies

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• Third-space fluid distribution of pemetrexed in non-small cell lung cancer patients — P.H. Honoré, S.J. Joensen, et al. (2014)
• The role of pemetrexed combined with targeted agents for non-small cell lung cancer — K. Konopa, J. Jassem (2010)
• Randomised phase II study of cisplatin-etoposide versus infusional carboplatin in advanced non-small-cell lung cancer and mesothelioma — S.C. White, H. Anderson, et al. (2000)
• Putative cancer stem cells in malignant pleural mesothelioma show resistance to cisplatin and pemetrexed — L. Cortes-Dericks, G.L. Carboni, et al. (2010)
• Interaction and cross-resistance of cisplatin and pemetrexed in malignant pleural mesothelioma cell lines — M. Kitazono-Saitoh, Y. Takiguchi, et al. (2012)

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