Erythema multiforme induced by regorafenib.
Erythema multiforme induced by regorafenib.
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DOI：
10.1002/jgf2.29
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发表时间：
2017-04
影响因子：
1.6
通讯作者：
Miwa K
中科院分区：
文献类型：
--
作者：
Matsunaga M;Ushijima T;Fukahori M;Tanikawa K;Miwa K
近年来，随着人口老龄化的加剧，癌症患者的数量也在不断增加。由于癌症患者数量的增加，即使是不专门从事癌症治疗的初级保健医生也可能有更多机会检查接受抗癌药物治疗的患者。近年来，口服多激酶抑制剂越来越多地用于抗癌药物治疗，该抑制剂可引起痤疮样疹和手足综合征等各种皮肤毒性。因此，皮肤毒性的管理对于继续治疗非常重要。在初级保健方面，似乎也有必要将癌症患者观察到的皮疹与抗癌药物引起的皮肤毒性区分开来。一名患有阑尾癌和腹膜播散的 29 岁男性接受瑞戈非尼作为三线化疗。 1 第一次瑞戈非尼疗程后 14 天，除面部外，患者全身出现大量红斑和融合性丘疹。皮疹主要为水肿性红斑，四肢尤为突出。它是在开始服用瑞戈非尼后出现的，而他既没有接受其他可能的致病药物，也没有感染或其他相关情况。皮肤活检除表皮有淋巴细胞浸润外，无其他特殊发现，与多形红斑的特征基本一致（图1）。根据临床病程和皮肤活检结果，患者被诊断为瑞戈非尼所致的 3 级多形红斑（图 1）。未观察到粘膜病变和手足皮肤反应。停止服用瑞戈非尼，并使用抗组胺药和类固醇治疗患者，皮疹得到缓解。随后，瑞戈非尼以减少的剂量恢复。尽管没有发现皮疹复发，但在第二个瑞戈非尼疗程后观察到疾病进展。由于患者全身状况恶化，治疗改为最佳支持治疗。
With the recent increase in the aging population, the number of cancer patients is also increasing. Because of this increase in the number of cancer patients, even primary care physicians who are not specialized in cancer treatment will presumably have more opportunities to examine patients undergoing treatment with anticancer medications. Recently, oral multikinase inhibitors, which can cause various skin toxicities, such as acneiform eruption and hand-foot syndrome, are increasingly used for anticancer drug therapy. Therefore, management of skin toxicity is very important for treatment continuation. In terms of primary care, it also seems necessary to differentiate rashes observed in cancer patients from skin toxicities due to anticancer medications. A 29-year-old man with appendiceal cancer and peritoneal dissemination received regorafenib as third-line chemotherapy. 1 Fourteen days after the first regorafenib course, numerous erythematous and coalescing papules were observed over the patient’s entire body, except for the face. The rash was mainly edematous erythema and was especially prominent on the extremities. It manifested after the start of regorafenib administration, while he neither received other possibly responsible agents nor had an infection or other relevant conditions. Skin biopsy revealed no specific findings except lymphocyte infiltration into the epidermis, which was largely consistent with the features of erythema multiforme (Figure 1). Based on the clinical course and the skin biopsy results, the patient was diagnosed with grade 3 erythema multiforme due to regorafenib (Figure 1). Neither mucosal lesions nor hand-foot skin reaction was observed. Regorafenib administration was stopped, and the patient was treated with antihistamines and steroids, which relieved the rash. Subsequently, regorafenib was resumed at a reduced dose. Although no relapse of the rash was noted, disease progression was observed after the second regorafenib course. Because the patient’s systemic condition worsened, the treatment was changed to the best supportive care.