ObjectiveTo improve the knowledge of erlotinib-induced severe rash and fatal interstitial lung disease (ILD).
MethodsThe clinical feature and radiology of erlotinib-associated severe rash and fatal ILD were analyzed in one patient with advanced non-small cell lung cancer (NSCLC) in the 81st Hospital of Chinese PLA,and the related literatures were reviewed.
ResultsThe patient was a 78-year-old male non-smoker with stage Ⅳ right lower lobe squamous cell carcinoma,and his epidermal growth factor receptor gene showed mutation at exon 21.He had a history of chronic obstructive pulmonary disease and mild pulmonary fibrosis.Following one cycle of chemotherapy with gemcitabine plus cisplatin,he received erlotinib 150 mg daily.After 40 days of targeting therapy,the size of the lung cancer was decreased significantly concomitant with severe rash.Again,severe rash and fatal ILD appeared after using erlotinib 100 mg daily for 4 days and 50 mg daily for 2 days,respectively.The tumor progressed markedly although both rash and ILD were almost abolished following withdrawal of erlotinib as well as empirical impact of glucocorticoid and sequential therapy.
ConclusionPhysicians should be alerted to the possibility of erlotinib-induced severe rash and fatal ILD.Those with pathologic findings of usual interstitial pneumonia on resected lung specimens or known pulmonary fibrosis may be at particular risk for erlotinib-related pulmonary toxicity.
ObjectiveIt has been reported that many different kinds of antiepileptic drugs (AEDs) induced cutaneous adverse drug reactions (cADRs) are associated with human leukocyte antigen (HLA) genes. However, previous studies mainly focused on the traditional AEDs. There are very few research focused on the new AEDs, especially levetiracetam (LEV). This study aimed to evaluate the clinical characteristics of LEV-induced cADRs and to explore its possible genetic association with the HLA alleles.
MethodsNine cases with LEV-induced cADRsfrom September 2011 to December 2014 were recruited. Demographic and clinical information of these cases was summarized. Additionally, cases were matched with LEV-tolerant controls (1 : 4).High-resolution HLA-A, -B, -DRB1 genotyping were performed for each subject. The allele frequencies between the cases and controls were compared.
ResultsNine cases with LEV-induced cADRs formed the LEV-cADRs group. And 36 epilepsy patients who had received or have been receiving LEV treatment for at least 3 months without any adverse drug reactions formed the LEV-tolerant controls group. All LEV-induced cADRs were mild skin rashes whichoccurred within 30 days of LEV exposure. The mean latency from LEV exposure to skin rash was (15.67±5.41) days (ranging 6~27). Two patients in the LEV-cADRs group carried the HLA-DRB1*0405allele, while none subjects in the control group carried this allele. The carrier rate of HLA-DRB1*0405 allele between the LEV-cADRs group and control group was statistical significant [P=0.036, OR=13.875, 95%CI(1.273, 151.230)].
ConclusionsSafety monitoring was necessary within four weeks after the initiation of LEV treatment, although it has been regarded as a safe AED.Our study suggested thatHLA-DRB1*0405 allele may be a risk factor for LEV-induced cADRs. However, the Further studies with large samples are needed to clarify this hypothesis and the genetic and immunological mechanisms of LEV-induced cADRs should also be further explored in the future.
ObjectiveTo systematically review the relationship between skin rashes and efficacy of cetuximab.
MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 1, 2013), CBM, CNKI and VIP were systemically searched to collect literature on relationship between the severity of skin rashes and efficacy of cetuximab published up to Aug. 2013. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software.
ResultsA total of 32 studies involving 1 543 patients were included. The results of metaanalysis showed that:the efficacy of cetuximab in patients with skin rashes was significantly superior to patients without skin rashes (RR=1.53, 95%CI 1.23 to 1.91, P=0.000 2); in addition, the efficacy of cetuximab in patients with severe skin rashes was significantly superior to patients with mild skin rashes (RR=2.42, 95%CI 1.89 to 3.11, P<0.000 01).
ConclusionSkin rashes are significantly associated with better efficacy of cetuximab.
