Skin/nail infections with the addition of pertuzumab to trastuzumab-based chemotherapy.
We report a series of breast cancer patients with invasive skin and nail infections with Staphylococcus species that we attribute to the addition of pertuzumab to trastuzumab-based therapy. With the suspicion of an increased incidence of cutaneous infection in patients treated with pertuzumab and trastuzumab-based chemotherapy, treating medical oncologists identified patients receiving therapy who experienced infection. Between March and October 2014, 18 patients treated with pertuzumab and trastuzumab-based chemotherapy were found to have 21 separate skin/nail infections. Treatment was administered as neoadjuvant therapy in 12 (67%) patients, adjuvant therapy in four (22%) patients, and for metastatic disease in two (11%) patients. Granulocyte growth factors were administered in 11 (61%) patients and no patients were documented to be neutropenic. New skin and nail lesions developed as early as cycle 1 and as late as 8 months from initial therapy. The 21 separate infections documented were folliculitis and "bite-like" lesions (10), abscess (6), paronychia (3), and cellulitis (2). The appearance of these lesions was distinct from typical EGFR-associated skin changes. When cultures were obtained, Staphylococcus species were isolated. Quantitative immunoglobulins were assessed in 14 (78%) patients and were abnormally low in six (43%) of these patients. The skin infections resulted in treatment delay in two (11%) patients and premature discontinuation of therapy in one patient. We believe that the skin/nail infections reported here in patients treated with the combination of pertuzumab and trastuzumab represent a previously unrecognized toxicity of adding pertuzumab to trastuzumab-based therapies.
Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, 1500 East Duarte Rd, Duarte, CA, 91010, USA, jmortimer@coh.org.
Joanne
J
Mortimer
Jae
J
Jung
Yuan
Y
Yuan
Laura
L
Kruper
Daphne
D
Stewart
Samuel
S
Chung
Kim Wai
KW
Yu
Mary
M
Mendelsohn
Massimo
M
D'Apuzzo
Bernard
B
Tegtmeier
Sanjeet
S
Dadwal
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009262:Nails / Q000187:drug effects / Q000473:pathology; D013203:Staphylococcal Infections / Q000139:chemically induced / Q000175:diagnosis / Q000473:pathology*; D013210:Staphylococcus / Q000187:drug effects / Q000472:pathogenicity; D000068878:Trastuzumab
D061067:Antibodies, Monoclonal, Humanized; C485206:pertuzumab; D000068878:Trastuzumab