Flynn Calvin R, Liu Shun-Chieh, Byrne Berbie, Ralph James, Paz Gabriela, Anwar Salman, Buchalter Jemma, Fitzpatrick Orla M, Markham Trevor, Donnellan Paul
Department of Medical Oncology, University Hospital Galway, Galway, Ireland.
Department of Dermatology, University Hospital Galway, Galway, Ireland.
Case Rep Oncol. 2023 Aug 16;16(1):652-661. doi: 10.1159/000532009. eCollection 2023 Jan-Dec.
Apalutamide is a novel nonsteroidal androgen receptor inhibitor that has been shown to improve outcomes for patients with nonmetastatic castration-resistant prostate cancer and metastatic castration-sensitive prostate cancer when combined with androgen deprivation therapy. Apalutamide-induced skin rash occurred commonly in clinical trials, with 23.8-27.1% of patients experiencing a rash of any grade, and 5.2-6.3% experiencing a rash of grade three or higher. There were no cases of severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) reported in clinical trials; however, there are rare cases reported in the literature with the majority occurring in Asian patients. An 83-year-old Caucasian male was commenced on apalutamide, combined with degarelix, for the management of metastatic castration-sensitive prostate cancer. During week five of apalutamide treatment, the patient developed a widespread erythematous maculopapular rash. On presentation, the rash affected 80% of his body surface area (BSA) and a diagnosis of a severe cutaneous drug eruption was made. He was commenced on methylprednisolone (MP) therapy. Despite 5 days of MP, the rash continued to deteriorate involving 95% of his BSA. Nikolsky's sign was positive. A diagnosis of overlap SJS/TEN was made, supported by skin biopsy. His SCORTEN score was three. He was then commenced on intravenous immunoglobulin and transferred to the intensive care unit. Over the coming days, the rash began to stabilise, and his steroid dose was weaned. He was discharged from hospital 38 days after rash onset. We report the first suggested case of apalutamide-induced SJS/TEN in a Caucasian patient. We discuss other cases of apalutamide-induced SCARs reported in the literature. Risk factors seem to include low body weight and Japanese race, as well as short time to onset of rash.
阿帕鲁胺是一种新型非甾体雄激素受体抑制剂，已证明与雄激素剥夺疗法联合使用时，可改善非转移性去势抵抗性前列腺癌和转移性去势敏感性前列腺癌患者的预后。阿帕鲁胺引起的皮疹在临床试验中很常见，23.8% - 27.1%的患者出现任何级别的皮疹，5.2% - 6.3%的患者出现三级或更高级别的皮疹。临床试验中未报告严重皮肤不良反应（SCARs），如史蒂文斯 - 约翰逊综合征（SJS）或中毒性表皮坏死松解症（TEN）；然而，文献中报告了罕见病例，大多数发生在亚洲患者中。一名83岁的白种男性开始使用阿帕鲁胺联合地加瑞克治疗转移性去势敏感性前列腺癌。在阿帕鲁胺治疗的第五周，患者出现广泛的红斑性斑丘疹皮疹。就诊时，皮疹累及他身体表面积（BSA）的80%，诊断为严重的药物性皮疹。他开始接受甲泼尼龙（MP）治疗。尽管使用了5天的MP，皮疹仍继续恶化，累及他BSA的95%。尼氏征阳性。皮肤活检支持重叠性SJS/TEN的诊断。他的SCORTEN评分为三分。然后他开始接受静脉注射免疫球蛋白并转入重症监护病房。在接下来的几天里，皮疹开始稳定，他的类固醇剂量逐渐减少。皮疹发作38天后他出院。我们报告了第一例白种患者中阿帕鲁胺引起的SJS/TEN疑似病例。我们讨论了文献中报道的其他阿帕鲁胺引起的SCARs病例。危险因素似乎包括低体重、日本种族以及皮疹发作时间短。
