Osimertinib-Induced Cutaneous Vasculitis Responsive to Low-Dose Dapsone Without Interruption of Anticancer Therapy: A Case Report and Review of the Literature
A 45-year-old woman with a history of lung adenocarcinoma treated with osimertinib developed purpuric plaques and vesicles on the lower extremities after 5 months of therapy. Skin biopsy revealed leukocytoclastic vasculitis (LCV). A workup for systemic involvement was unremarkable. The patient was t...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-11-01
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| Series: | JTO Clinical and Research Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666364322001394 |
| _version_ | 1828127197960863744 |
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| author | Christopher Iriarte, MD Jonathan H. Young, MD, PhD Michael S. Rabin, MD Nicole R. LeBoeuf, MD, MPH |
| author_facet | Christopher Iriarte, MD Jonathan H. Young, MD, PhD Michael S. Rabin, MD Nicole R. LeBoeuf, MD, MPH |
| author_sort | Christopher Iriarte, MD |
| collection | DOAJ |
| description | A 45-year-old woman with a history of lung adenocarcinoma treated with osimertinib developed purpuric plaques and vesicles on the lower extremities after 5 months of therapy. Skin biopsy revealed leukocytoclastic vasculitis (LCV). A workup for systemic involvement was unremarkable. The patient was treated with oral dapsone while continuing osimertinib without interruption. Skin lesions cleared within 2 weeks of therapy with no recurrence after titrating off dapsone. To the best of our knowledge, this is the first reported case of LCV induced by a small-molecule EGFR inhibitor in which therapy was not interrupted. This is also the first reported case treated with dapsone rather than systemic corticosteroids. We suggest consideration of dapsone to treat skin-limited LCV induced by EGFR inhibitors in patients with lung cancer without features of systemic vasculitis. In addition, this case highlights that it may not be necessary to stop EGFR inhibitor therapy in the absence of severe features such as ulceration, bullae, necrosis, or severe pain. Dapsone is an effective targeted therapy for cutaneous LCV that does not globally impair the immune system and may allow for uninterrupted treatment of the underlying malignancy. |
| first_indexed | 2024-04-11T15:46:43Z |
| format | Article |
| id | doaj.art-32d523b9ad9f451da4e1b1353f6e6723 |
| institution | Directory Open Access Journal |
| issn | 2666-3643 |
| language | English |
| last_indexed | 2024-04-11T15:46:43Z |
| publishDate | 2022-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj.art-32d523b9ad9f451da4e1b1353f6e67232022-12-22T04:15:31ZengElsevierJTO Clinical and Research Reports2666-36432022-11-01311100415Osimertinib-Induced Cutaneous Vasculitis Responsive to Low-Dose Dapsone Without Interruption of Anticancer Therapy: A Case Report and Review of the LiteratureChristopher Iriarte, MD0Jonathan H. Young, MD, PhD1Michael S. Rabin, MD2Nicole R. LeBoeuf, MD, MPH3Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts; Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, MassachusettsHarvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women’s Hospital, Boston, MassachusettsHarvard Medical School, Boston, Massachusetts; Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MassachusettsDepartment of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts; Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Corresponding author. Address for correspondence: Nicole R. LeBoeuf, MD, MPH, Center for Cutaneous Oncology Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115.A 45-year-old woman with a history of lung adenocarcinoma treated with osimertinib developed purpuric plaques and vesicles on the lower extremities after 5 months of therapy. Skin biopsy revealed leukocytoclastic vasculitis (LCV). A workup for systemic involvement was unremarkable. The patient was treated with oral dapsone while continuing osimertinib without interruption. Skin lesions cleared within 2 weeks of therapy with no recurrence after titrating off dapsone. To the best of our knowledge, this is the first reported case of LCV induced by a small-molecule EGFR inhibitor in which therapy was not interrupted. This is also the first reported case treated with dapsone rather than systemic corticosteroids. We suggest consideration of dapsone to treat skin-limited LCV induced by EGFR inhibitors in patients with lung cancer without features of systemic vasculitis. In addition, this case highlights that it may not be necessary to stop EGFR inhibitor therapy in the absence of severe features such as ulceration, bullae, necrosis, or severe pain. Dapsone is an effective targeted therapy for cutaneous LCV that does not globally impair the immune system and may allow for uninterrupted treatment of the underlying malignancy.http://www.sciencedirect.com/science/article/pii/S2666364322001394Cutaneous vasculitisOsimertinibEpidermal growth factor receptor inhibitorCase reportDapsone |
| spellingShingle | Christopher Iriarte, MD Jonathan H. Young, MD, PhD Michael S. Rabin, MD Nicole R. LeBoeuf, MD, MPH Osimertinib-Induced Cutaneous Vasculitis Responsive to Low-Dose Dapsone Without Interruption of Anticancer Therapy: A Case Report and Review of the Literature JTO Clinical and Research Reports Cutaneous vasculitis Osimertinib Epidermal growth factor receptor inhibitor Case report Dapsone |
| title | Osimertinib-Induced Cutaneous Vasculitis Responsive to Low-Dose Dapsone Without Interruption of Anticancer Therapy: A Case Report and Review of the Literature |
| title_full | Osimertinib-Induced Cutaneous Vasculitis Responsive to Low-Dose Dapsone Without Interruption of Anticancer Therapy: A Case Report and Review of the Literature |
| title_fullStr | Osimertinib-Induced Cutaneous Vasculitis Responsive to Low-Dose Dapsone Without Interruption of Anticancer Therapy: A Case Report and Review of the Literature |
| title_full_unstemmed | Osimertinib-Induced Cutaneous Vasculitis Responsive to Low-Dose Dapsone Without Interruption of Anticancer Therapy: A Case Report and Review of the Literature |
| title_short | Osimertinib-Induced Cutaneous Vasculitis Responsive to Low-Dose Dapsone Without Interruption of Anticancer Therapy: A Case Report and Review of the Literature |
| title_sort | osimertinib induced cutaneous vasculitis responsive to low dose dapsone without interruption of anticancer therapy a case report and review of the literature |
| topic | Cutaneous vasculitis Osimertinib Epidermal growth factor receptor inhibitor Case report Dapsone |
| url | http://www.sciencedirect.com/science/article/pii/S2666364322001394 |
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