Cotena Claudia, Gisondi Paolo, Colato Chiara, Girolomoni Giampiero
Department of Biomedical and Surgical Science, University of Verona, Verona, Italy.
Acta Dermatovenerol Croat. 2007;15(4):246-8.
Cetuximab is a recombinant human/mouse chimeric monoclonal antibody that targets the extracellular domain of the epidermal growth factor receptor (EGFR). Cetuximab is approved by the US Food and Drug Administration for the treatment of EGFR-expressing metastatic colorectal cancer as monotherapy in patients who are intolerant to irinotecan-based chemotherapy, or in combination with irinotecan in patients who are refractory to irinotecan-based chemotherapy. Due to the important role of the EGFR in skin homeostasis, cutaneous reactions are a common adverse effect of cetuximab, mainly as acneiform follicular eruption seen in almost 85% of patients. We report on a 46-year-old female Caucasian patient with metastatic colorectal cancer, referred to our department for acneiform eruption induced by cetuximab in combination with irinotecan. Four days after the first infusion the patient developed intense acneiform eruption consisting of erythematous follicular papules and pustules spread to the face, neck and upper part of the trunk, accompanied by intense pruritus and fever (38.0 degrees C). There were no comedones. Biopsy specimen revealed superficial and florid neutrophilic suppurative folliculitis. She was treated with erythromycin tablet 600 mg, three times a day for 1 month, and topical clindamycin solution 3%. After 1 month of treatment, the lesions consistently faded, and the patient continued receiving immunochemotherapy.
西妥昔单抗是一种重组人/鼠嵌合单克隆抗体，靶向表皮生长因子受体（EGFR）的细胞外结构域。西妥昔单抗已获美国食品药品监督管理局批准，用于治疗表达EGFR的转移性结直肠癌，可作为不耐受基于伊立替康化疗的患者的单一疗法，或作为对基于伊立替康化疗难治的患者与伊立替康联合使用的疗法。由于EGFR在皮肤稳态中起重要作用，皮肤反应是西妥昔单抗常见的不良反应，主要表现为痤疮样毛囊疹，几乎85%的患者都会出现。我们报告了一名46岁的白种女性转移性结直肠癌患者，因西妥昔单抗联合伊立替康诱发痤疮样疹转诊至我科。首次输注后4天，患者出现严重的痤疮样疹，表现为红斑性毛囊丘疹和脓疱，蔓延至面部、颈部和躯干上部，伴有剧烈瘙痒和发热（38.0摄氏度）。无粉刺。活检标本显示为浅表性和明显的嗜中性化脓性毛囊炎。给予患者红霉素片600毫克，每日3次，共1个月，以及3%的外用克林霉素溶液。治疗1个月后，皮损持续消退，患者继续接受免疫化疗。
