Department of Pharmacy, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, 300 W 10th Ave, Columbus, OH, 43210, USA.
Support Care Cancer. 2013 Oct;21(10):2679-86. doi: 10.1007/s00520-013-1842-3. Epub 2013 May 19.
As the result of a recent national shortage in paclitaxel, some patients who were receiving or scheduled to receive weekly paclitaxel were converted to every 3-week (q3w) docetaxel with granulocyte colony-stimulating factor support. Our institution noted higher than expected incidence of severe skin toxicity events attributable to docetaxel during the shortage period among our breast cancer patients. In this report, we summarize the clinical course of the first five cases, review the literature surrounding docetaxel-induced skin toxicity, and offer possible prevention and treatment strategies to improve docetaxel tolerability.
The observation period for this case series was August 1 through October 21, 2011. All patients treated with docetaxel were identified from our electronic medical record. Operable stage I-III breast cancer patients who received ≥ 1 dose of docetaxel monotherapy at 75-100 mg/m(2) q3w were included in this study. The cases of grade 3-4 docetaxel-induced skin toxicities identified by the treating oncologists were then contacted and signed an informed consent through an Institutional Review Board-approved protocol.
Thirty-four patients met the inclusion criteria. Five patients (14.7 %) experienced grade 3 skin toxicity events attributable to docetaxel, a significantly higher rate than previously reported for docetaxel dosed at 75-100 mg/m(2).
Docetaxel-induced dermatologic toxicity is well characterized; nonetheless, its etiology is largely unknown and evidence-based prevention and management strategies are lacking. This report shows that the use of docetaxel 75-100 mg/m(2) q3w subsequent to dose-dense doxorubicin and cyclophosphamide regimen can lead to unacceptable rate of severe skin toxicity.
由于最近紫杉醇短缺，一些正在接受或计划接受每周紫杉醇治疗的患者被转换为每 3 周（q3w）给予多西紫杉醇并支持粒细胞集落刺激因子治疗。在短缺期间，我们机构注意到乳腺癌患者中归因于多西紫杉醇的严重皮肤毒性事件发生率高于预期。在本报告中，我们总结了前 5 例患者的临床经过，回顾了多西紫杉醇引起的皮肤毒性相关文献，并提出了可能的预防和治疗策略，以提高多西紫杉醇的耐受性。
本病例系列的观察期为 2011 年 8 月 1 日至 10 月 21 日。从我们的电子病历中确定了所有接受多西紫杉醇治疗的患者。纳入本研究的患者为接受 ≥ 1 剂 75-100mg/m2 q3w 多西紫杉醇单药治疗的可手术 I-III 期乳腺癌患者。通过治疗肿瘤学家确定的 3-4 级多西紫杉醇引起的皮肤毒性病例，然后联系并通过机构审查委员会批准的方案签署知情同意书。
34 名患者符合纳入标准。5 名患者（14.7%）发生了归因于多西紫杉醇的 3 级皮肤毒性事件，这一发生率明显高于先前报道的 75-100mg/m2 剂量的多西紫杉醇。
多西紫杉醇引起的皮肤毒性反应特征明确；然而，其病因在很大程度上是未知的，缺乏基于证据的预防和管理策略。本报告表明，在密集型多柔比星和环磷酰胺方案后使用多西紫杉醇 75-100mg/m2 q3w 可导致无法接受的严重皮肤毒性发生率。
