Reactions 1278 - 14 Nov 2009

★ SCetuximab/panitumumab

First report of Stevens-Johnson syndrome: casereport

A 46-year-old woman developed Stevens-Johnsonsyndrome with reduced tear production after treatmentwith cetuximab and then panitumumab for metastaticcolon cancer.

The woman, who had been diagnosed with colon cancerin 1999, had undergone numerous resections withadjuvant chemotherapy (Mayo Clinic protocol) andFOLFOX IV. She began receiving chemoimmunotherapywith cetuximab (loading dose of 400 mg/m2 and then250 mg/m2 weekly) and irinotecan in April 2005 after lungmetastases were found; she received 40 courses until newdisease progression was observed. She then receivedbevacizumab and irinotecan and FOLFOX chemotherapy.She was subsequently retreated with cetuximab [dosagenot stated] and irinotecan and, after 9 cycles, shedeveloped a maculopapular skin eruption on her neck,forearms and head that progressed quickly to target lesionsand bullae, with severe periorbital oedema. She had sheet-like epidermis loss, flaccid raised blisters that spread withpressure and regions of erythema that demonstratedNikolsky’s sign. In addition, severe blepharoconjunctivitisdeveloped along with superficial punctuate keratopathyand intense photophobia; there was a severe reduction oftear production (Schirmer test 0 mm/5min bilaterally). Asless than 10% of her body surface was involved, she wasdiagnosed with Stevens-Johnson syndrome.

Cetuximab was stopped and the woman receivedmethylprednisolone and empiric antibacterials. In a fewdays, she had progressive improvement of her symptomsand she had regained completely normal skin appearanceafter 1 month. Her ocular surface was healthy and she hadnormal tear production. Due to this severe adversereaction, her began alternative treatment of panitumumab3 mg/m2 biweekly and irinotecan. After two doses,widespread erythema and blistering again developed,involving more than 10% of her body; she was againdiagnosed with Stevens-Johnson syndrome. The treatmentand evolution of this reaction was the same as that of herprevious episode [patient outcome not stated].

Author comment: "The suggestive and strict temporalrelationship between the administration of the two differentanti-[epidermal growth factor receptor (EGFR)] drugs and thedevelopment of this syndrome strongly suggest therelationship between anti-EGFR therapy and this syndrome".Pantano F, et al. Stevens-Johnson syndrome associated with reduced tearproduction complicating the use of cetuximab and panitunumab. InternationalJournal of Colorectal Disease 24: 1247-1248, No. 10, 2009 - Italy 801154487

» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports of Stevens-Johnson syndrome associated with cetuximab orpanitumumab. The WHO ADR database contained onereport of Stevens-Johnson syndrome associated withcetuximab and one report of Stevens-Johnson syndromeassociated with panitumumab.

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Reactions 14 Nov 2009 No. 12780114-9954/10/1278-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved