[Safety of reintroduction of erlotinib at low doses following hand-foot syndrome induced by erlotinib treatment for a Pancoast-Tobias tumour].

INTRODUCTION

Erlotinib, an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), is a targeted therapy used in first, second or third line treatment of non-small cell lung carcinoma. Several cutaneous toxicities after the use of EGFR-TKI are well-described.

OBSERVATION

After 13 days of erlotinib treatment, an 82-year-old man, diagnosed with squamous cell lung carcinoma, developed an acneiform rash in parallel with hand-foot syndrome (HFS). This led to the interruption of his treatment because of the patient's distress. However, for the first time and after a total recovery of the toxidermia, we reintroduced the therapy at very low doses without any HFS recurrence being observed.

DISCUSSION

The HFS is a dose-dependent toxidermia appearing within the first week following administration of the triggering cytotoxic agents (chemotherapies or target therapies). It appears that a specific pathogenic mechanism exists for each cytotoxic agent triggering the skin damage, resulting in different clinical presentations. A major aspect of HFS treatment involves the reduction or withdrawal of the treatment.

CONCLUSIONS

We describe what is to our knowledge, the third case of erlotinib-induced HFS, a new secondary undesirable skin pathology for which, currently, exist few direct causal explanations or drug monitoring. This observation highlights the importance of broadening our knowledge of the exact mechanisms linking EGFR-TKI to the appearance of HFS in order to optimize treatment.