Toxic epidermal necrolysis related to pemetrexed and carboplatin with vitamin B12 and folic acid supplementation for advanced non-small cell lung cancer.
BACKGROUND
Pemetrexed is a multitargeted antifolate initially approved as a single agent for the second-line treatment of locally advanced or metastatic non-small cell lung cancer and more recently in the first-line setting combined with cisplatin. The combination of pemetrexed with carboplatin has been tested in several phase II clinical trials showing interesting antitumour activity with mild toxicity. Supplementation with folic acid and vitamin B12 during treatment with pemetrexed is recommended to reduce potential haematological and gastrointestinal adverse events.


METHODS
A patient experienced cutaneous lesions including widespread erythema, epidermal detachment, and skin denudation, associated with deterioration of his general condition after the second cycle of this chemotherapy combination, which was clinically and histologically compatible with toxic epidermal necrolysis (Lyell's syndrome). Treatment with systemic steroids, antihistamines, and antibiotics led to resolution of the skin lesions and improvement of his general condition.


CONCLUSIONS
To our knowledge, this is the second case reported in the literature of this type of suspected adverse drug reaction associated with a pemetrexed-based chemotherapy combination.
Bosch-Barrera
Joaquim
J
Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain.
Gaztañaga
Miren
M
Ceballos
Jaime
J
Pérez-Gracia
José L
JL
López-Picazo
José M
JM
García-Foncillas
Jesús
J
Ferrer
Marta
M
Sanz
María L
ML
Pretel
Maider
M
Idoate
Miguel A
MA
Gil-Bazo
Ignacio
I
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D016190:Carboplatin / Q000009:adverse effects* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000188:drug therapy; D005492:Folic Acid / Q000009:adverse effects / Q000627:therapeutic use; D005971:Glutamates / Q000009:adverse 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; D008297:Male; D008875:Middle Aged; D000068437:Pemetrexed; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D014805:Vitamin B 12 / Q000009:adverse effects / Q000627:therapeutic use
D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine; D005492:Folic Acid; D016190:Carboplatin; D014805:Vitamin B 12