Reactions 1143 - 17 Mar 2007

★Cetuximab

First report of ectropion: case reportA 49-year-old man developed ectropion during a cetuximab-

containing antineoplastic regimen for colorectal cancer.The man started receiving weekly infusions of cetuximab

[dose not stated] in addition to his baseline treatment offluorouracil and irinotecan. One week later, he developedbilateral eyelid and periorbital skin irritation with epiphora anda foreign-body sensation. He was initially diagnosed withcicatricial ectropion and received topical corticosteroid dropsand ointment; his symptoms persisted. Over the ensuing3 weeks, he developed severe crusting of the skin of his lowerand upper eyelids with intermittent bleeding and loss of hiseyelashes. He was referred for oculoplastic examination aftercompleting his fourth weekly cetuximab infusion. Externalexamination showed cicatricial ectropion of his lower eyelidmargins, in the setting of tight skin of his lower and uppereyelids and cheeks. The tear meniscus was high in both eyesand both lower puncta were everted. Slit-lamp examinationrevealed a minimally hyperemic conjunctiva without mucosalscarring. He reported that cetuximab was probably going to bediscontinued in 2 weeks due to a lack of systemic response.

The man was treated with a conservative regimen of artificialtears, erythromycin ointment applied to both eyes anddesonide ointment applied to his eyelid skin. Cetuximab wasstopped as planned, and at 6-weeks’ follow-up, his ocular andskin irritation with epiphora had fully resolved. Examinationrevealed resolution of ectropion, eyelash regrowth, non-inflamed eyelid margins and a white, quiet conjunctiva. Histear meniscus was still high, which was suspected to bepotentially related to prolonged treatment with fluorouracil.

Author comment: "Systemic [fluorouracil] has beenassociated with cicatricial ectropion, and it is possible that theconcomitant use of [fluorouracil] influenced the type andseverity of the patient’s cutaneous toxicity. However, thepatient’s therapy with both [fluorouracil] and irinotecanpreceded his cutaneous toxicity and continued after theresolution of his periocular findings, strongly suggesting thatcetuximab was the causative agent."Garibaldi DC, et al. Cicatricial ectropion associated with treatment of metastaticcolorectal cancer with cetuximab. Ophthalmic Plastic and Reconstructive Surgery23: 62-63, No. 1, Jan-Feb 2007 - USA 801062769

» Editorial comment: A search of AdisBase, Medline and theWHO Adverse Drug Reactions database did not reveal anyprevious case reports of ectropion associated with cetuximab.

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Reactions 17 Mar 2007 No. 11430114-9954/10/1143-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved