Unfavorable HBsAg, Hepatitis C, and autoantibodies (ANA, anti ds DNA, anti-Ro, anti-SS-A/SS-B, anti-histone, anti-Smith)Tokunaga em et al /em

Unfavorable HBsAg, Hepatitis C, and autoantibodies (ANA, anti ds DNA, anti-Ro, anti-SS-A/SS-B, anti-histone, anti-Smith)Tokunaga em et al /em . of breast malignancy with metastasis to lungs having paclitaxel-induced photodermatitis after 4 weeks of weekly paclitaxel and trastuzumab. The photodermatitis resolved after discontinuation of paclitaxel while trastuzumab was continued. Our patient developed characteristic photodermatitis after 10 weeks of combination chemotherapy that resolved following paclitaxel withdrawal in a similar manner. Although we could not perform drug rechallenge, paclitaxel could be implicated for the onset of photodermatitis following its administration (temporal correlation) and resolution of rash and no more recurrence after its discontinuation (de-challenge) as per the World Health Business Uppsala Monitoring Center causality scale. Table 1 Reported adverse Fagomine effects of paclitaxel and trastuzumab thead th align=”left” rowspan=”1″ colspan=”1″ Type of adverse effects /th th align=”left” rowspan=”1″ colspan=”1″ Paclitaxel /th th align=”left” rowspan=”1″ colspan=”1″ Trastuzumab /th /thead Hypersensitivity reactionsAngioedemaAngioedemaUrticariaUrticariaAnaphylaxisAnaphylaxisFlushing/pruritusMorbilliform rashMorbilliform rashCutaneous adverse effectsHand and foot syndromeHand and foot syndrome (in combination with paclitaxel)PATEO syndromeIntertriginous drug rashMaculopapular drug rashPhotodistributed EMPhotodermatitisAGEPFlagellate and reticulate pigmentationDrug-induced LE/SCLESclerodermatus skin changesRecall (radiation/UV) dermatitisInflammation of actinic keratosesSJS/TENAdverse effects affecting hair and nailsAlopecia – reversible/persistentOnychoytrophy/onychopathy (in combination with docetaxel)Onycholysis/photo onycholysisOnychopathyOnychomadesis, Beaus linesMelanonychia/leukonychiaParonychiaOnychorrhexisAdverse effects affecting mucosal surfacesMucositis-DysgeusiaTongue pigmentationMiscellaneousFixed drug eruptions-Hot flashesInflammation in actinic keratosisXerosis Open in a separate window Most of these adverse effects are documented in literature as case reports, small case series, or in postmarketing surveys. AGEP=Acute generalized exanthematous pustulosis, PATEO=Periarticular thenar erythema with onycholysis, EM=Erythema multiforme, LE=Lupus erythematosus, SJS=Stevens-Johnson syndrome, TEN=Toxic epidermal necrolysis, SCLE=Subacute cutaneous lupus erythematosus, UV=Ultraviolet Table 2 Characteristics of patients with paclitaxel-induced photodermatitis thead th align=”left” rowspan=”1″ colspan=”1″ Reference number /th th align=”center” rowspan=”1″ colspan=”1″ Case number /th th align=”left” rowspan=”1″ colspan=”1″ Age in years/gender /th th align=”left” rowspan=”1″ colspan=”1″ Main diagnosis /th th align=”left” rowspan=”1″ colspan=”1″ Chemotherapy routine /th th align=”left” rowspan=”1″ colspan=”1″ Quantity of chemotherapy courses (duration) before the onset of rash /th th align=”left” rowspan=”1″ colspan=”1″ Remarks /th /thead Cohen em et al /em . 2009[1]140/femaleBreast malignancy with metastasis to lungsPaclitaxel (160 mg/week) + Trastuzumab 225 mg/week followed Mouse monoclonal to Neuron-specific class III beta Tubulin by 110 mg/week for 3 m4 treatment courses (4 weeks)Experienced earlier received docetaxel without responseLesional biopsy showed vacuolar degeneration of basal cells, sparse necrotic keratinocytes, papillary dermal edema, perivascular mononuclear cell infiltrateIncreased urinary porphyrins (ALA, PBG, PBGD)Ferreira em et al /em . 2010[3]260/maleNonsmall cell lung malignancy with bone metastasisDocetaxel + local radiotherapy2 treatment Fagomine courses br / (2 weeks)Treated earlier with left pneumonectomy + carboplatin and vinorelbineDose and routine of docetaxel administration not mentionedOnycholysis was presentBeutler em et al /em . 2015[4]369/femaleNonsmall cell lung malignancy (stage-IV) with bone metastasisNab-paclitaxel 100 mg/m2 (185 mg)/week4 treatment courses br Fagomine / (4 weeks)Lesional biopsy showed hyperkeratosis, moderate spongiosis, scattered dyskeratotic cells, sparse interface dermatitis, moderate melanin incontinence, and increased mucinNormal CK, aldolase, LDH, AST, and ALT. ANA +Unfavorable autoantibodies for dsDNA, RO, LA, Smith, RNP, SCl-70, Jo-1, and histoneAkay em et al /em . 2010[5]463/femaleMetastatic breast carcinomaDocetaxel 75 mg/m2 + Trastuzumab 8 mg/kg followed by 6 mg/kg, at every 3 weeksTwo treatment courses (2 weeks)Lesional biopsy showed lymphocytic cell infiltrateIncreased total urinary porphyrins, UP, PCP, CPNormal ALA, PBGNormal C3/C4, and liver enzymes. Unfavorable HBsAg, Hepatitis C, and autoantibodies (ANA, anti Fagomine ds DNA, anti-Ro, anti-SS-A/SS-B, anti-histone, anti-Smith)Tokunaga em et al /em . 2013[6]5Male (age not stated)Scalp angiosarcomaDocetaxel (dosing routine not provided)3 m after initiating docetaxelReviewed other Fagomine five patients with photosensitivity from 2 to 22 courses of docetaxel/paclitaxel treatment coursesAll showed increased erythrocyte protoporphyrinAll shoed sensitivity to UV-B light on photo testingRash resolved with topical steroid ointmentPresent case670/femaleIntraductal breast carcinoma with metastasis to lymph nodesPaclitaxel (130 mg/week) + Trastuzumab (270 mg/week followed by 135 mg/week)10 treatment courses (10 weeks)Radical mastectomy performed prior to chemotherapySkin biopsy or estimation of urinary porphyrins not performed for need of consent/in house facilityBlood biochemistry, hemogram was normalPhoto dermatitis resolved after withdrawal of paclitaxel Open in a separate windows ANA=Antinuclear antibody, ALA=Aminolevulinic acid, CK=Creatine kinase, PBG=Porphobilinogen, PBGD=Porphobilinogen deaminase, UP=Uroporphyrin, PCP=Pentacarboxyporphyrin, CP=Coproporphyrin-I and III, LDH=Lactate dehydrogenase, AST=Aspartate aminotransferase, ALT=Alanine aminotransferase, HBsAg=Hepatitis B computer virus surface antigen, UVB=Ultraviolet-B Although pathomechanism of paclitaxel-induced photodermatitis is usually poorly understood for its rarity, nab-paclitaxel, and more frequently, docetaxel as monotherapy or in combination with trastuzumab have caused photodermatitis after 2C4 weekly treatments.[3,4,5,6] It has been usually imputed to nonspecific increased porphyrin synthesis.