title: Unsuccessful rechallenge with pemetrexed after a previous radiation recall dermatitis.
abstract: Radiation recall dermatitis is characterized by an inflammatory reaction within a previously irradiated volume after administration of a drug. Antineoplastic drugs have mainly been involved in radiation recall reactions. This phenomenon is well known but poorly understood. Many hypotheses as stem-cell depletion in the radiotherapy field, heritable mutations within surviving stem cells, local vascular changes as well as a drug hypersensitivity reaction have been proposed to explain these reactions. In this report, we describe a non-small cell lung cancer patient treated with a carboplatin plus gemcitabine combination chemotherapy as first line followed by pemetrexed as second line therapy. Twenty-five years ago, she completed radiation therapy for breast cancer. Three days after the first cycle of pemetrexed, she presented with a radiation recall dermatitis. As EGFR-staining was negative, we rechallenged the patient with pemetrexed. Unfortunately, although less intense, we faced a recurrence of the skin reaction and pemetrexed was no longer continued.
authors.affiliation: Faculty of Medicine, Université de la Méditerranée, Department of Thoracic Oncology, Respiratory Diseases Division, Hôpital Sainte-Marguerite, Marseille Cedex 09, France. fabrice.barlesi@mail.ap-hm.fr
authors.forename: Fabrice
authors.initials: F
authors.lastname: Barlési
authors.forename: Céline
authors.initials: C
authors.lastname: Tummino
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Tasei
authors.forename: Philippe
authors.initials: P
authors.lastname: Astoul
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000532:radiotherapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005971:Glutamates / Q000009:adverse effects* / Q000187:drug effects* / Q000627:therapeutic use; D006147:Guanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy*; D000068437:Pemetrexed; D011855:Radiodermatitis / Q000139:chemically induced / Q000175:diagnosis* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine