Toxic epidermal necrolysis related to pemetrexed and carboplatin with vitamin B12 and folic acid supplementation for advanced non-small cell lung cancer.
Joaquim Bosch-Barrera (a), Miren Gaztañaga (a), Jaime Ceballos (a), José L. Pérez-Gracia (a), José M. López-Picazo (a), Jesús García-Foncillas (a), Marta Ferrer (b), María L. Sanz (b), Maider Pretel (c), Miguel A. Idoate (d), Ignacio Gil-Bazo (a)
(a) Department of Oncology
(b) Department of Allergy and Clinical Immunology
(c) Department of Dermatology
(d) Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
Pemetrexed is a multitargeted antifolate initially approved as a single agent for the second-line treatment of locally advanced or metastatic non-small cell lung cancer and more recently in the first-line setting combined with cisplatin. The combination of pemetrexed with carboplatin has been tested in several phase II clinical trials showing interesting antitumour activity with mild toxicity. Supplementation with folic acid and vitamin B12 during treatment with pemetrexed is recommended to reduce potential haematological and gastrointestinal adverse events.
A patient experienced cutaneous lesions including widespread erythema, epidermal detachment, and skin denudation, associated with deterioration of his general condition after the second cycle of this chemotherapy combination, which was clinically and histologically compatible with toxic epidermal necrolysis (Lyell's syndrome). Treatment with systemic steroids, antihistamines, and antibiotics led to resolution of the skin lesions and improvement of his general condition.
To our knowledge, this is the second case reported in the literature of this type of suspected adverse drug reaction associated with a pemetrexed-based chemotherapy combination.
CITATION Onkologie. 2009 Oct;32(10):580-4