Leukocytoclastic Vasulitis Induced by Gefitinib / 대한피부과학회지

Gefitinib (Iressa(R), AstraZeneca) is an oral form of an anticancer drug called epidermal growth factor receptor-tyrosine kinase inhibitor. It is widely used for various solid cancers, including lung cancer. Cutaneous adverse reactions induced by gefitinib have recently been reported with an incidence ranging from 49% to 100%, and they include acneiform skin rash, hyperpigmentation, xerotic skin, pruritus, skin fissures, nail change and disorders of the mucous membranes, eyes and hair. To the best of our knowledge, no cases of leukocytoclastic vasculitis associated with gefitinib have ever been published in the Korean medical literature, and there have been only four such reported cases in other countries. Herein, we report on a case of leukocytoclastic vasulitis induced by gefitinib in a patient with lung cancer.

Paronychia during Iressa(R) Treatment in a Lung Cancer Patient / 대한피부과학회지

Iressa(R) (ZD 1839, gefitinib) is a new anti-cancer agent which selectively inhibits the epidermal growth factor receptor (EGFR) tyrosine kinase in the pathway of the signal transduction. This agent can induce adverse effects in the cutaneous which are related to the interruption of normal epidermal cell kinetics. We report a case of paronychia in a 65-year-old man, developed in both sides of his finger and toe nails during treatment of non-small cell lung cancer (Stage IV) with Iressa(R) for 7 days. The patient came to our clinic with painful periungal inflammation with granulation tissue formation. The lesion was improved after treatment with topical or systemic antibiotics, Burrow's solution (0.3% aluminum acetate) soaking and electrodessication.

Study of Clinical Features of Cutaneous Side Effects Associated with ZD 1839 / 대한피부과학회지

BACKGROUND: ZD1839 (Iressa(R)Gefitinib) is an orally active, selective epidermal growth factor (EGF) receptor tyrosine kinase inhibitor that blocks signal production pathways in cell proliferation. It is currently used in the treatment of advanced stage non-small cell lung cancer. Cutaneous side effects commonly associated with ZD 1839 treatment include acneiform eruption, dry skin and hair growth abnormalities. Cutaneous eruptions result from direct interference with functions of EGF receptor signaling in the skin. OBJECTIVE: The purpose of our study was to investigate the clinical features of cutaneous side effects of ZD 1839 in Korean with literature review. We also analysed the relationship between skin rash severity, onset and objective tumor response. METHOD: We retrospectively reviewed medical records and the histologic materials of 23 Korean patients who had been treated with ZD 1839 at Ajou University Hospital from March 2002 to September 2003 . RESULTS: The results are summarized as follows. 1. The most common cutaneous side effect was acneiform skin rash (56%) which is a well known complication of ZD 1839. 2. Acneiform eruptions were easily controlled by oral antibiotics, such as minocycline and topical retinoid ointment. 3. The second common side effect was dry scaly skin (43%). 4. We also found acute paronychia, finger tip desquamation, alopecia and intertrigo. 5. The severity of the skin rash correlated well with the treatment response of ZD 1839. 6. When the skin rash appeared within 1 week after taking ZD 1839, the skin rash was severe, and the tumor responded well to the ZD 1839. CONCLUSION: The results of this study suggest that acneiform eruption and dry skin are the most common cutaneous side effects of ZD 1839. The association between rash severity and onset of tumor response suggests that the rash may serve as a marker of response to ZD1839 therapy and may be used to guide treatment to obtain optimal response. However, further prospective studies on the potentially important association between rash severity or onset and outcome of treatment with ZD 1839 are needed.

Cutaneous Adverse Effects Associated with Iressa(R)(Gefitinib) Medication / 대한피부과학회지

We report cutaneous adverse effects developed in three patients and are probably related to Iressa(R)(Gefitinib, ZD1839) medication. Iressa(R) is a new anti-cancer agent which acts by inhibiting epidermal growth factor (EGF) receptor signal transduction. The three patients had all taken Iressa(R) for treatment of non-small cell lung cancer and came to our clinic with cutaneous adverse effects. All three patients had acneiform eruptions, and one of the patients also had periungal granulation lesions. Histopathologically, periadnexal inflammatory cellular infiltrations were seen in the acneiform lesions of the three patients and granulation-like tissue proliferations in periungal granulation lesions of the one patient.

A Case of Paronychia, Acneiform Eruption and Dry Skin Induced by Iressa(R) / 대한피부과학회지

Iressa(R) (ZD1839) is a new anticancer agent, acting as a selective epidermal growth factor receptor tyrosine kinase inhibitor. Iressa(R) has been generally well-tolerated in cancer patients. Predominant adverse effects are an acne-like skin rash, diarrhea, nausea, vomiting, dry skin, and mild to moderate myelosuppression. The side effect of paronychia or alopecia is rare. We report a case of paronychia with granulation tissue induced by Iressa(R). Our patient complained of an acneiform eruption on his face and xerosis on his left arm and both feet as well as paronychia of several finger and toe nails.

A Case of Hair Change and Acneiform Eruption Induced by ZD1839 (Iressa(R)) / 대한피부과학회지

ZD1839 (Iressa(R)) is a new anticancer agent, a selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor that blocks signal transduction pathway implicated in the proliferation and survival of cancer cells and other host-dependent process promoting cancer growth. But this agent can induce cutaneous side effects including acneiform eruption, dry skin, and hair abnormality, which is related with the interruption of normal epidermal and hair follicular kinetics. We report a case of hair change and acneiform eruption induced by ZD1839 (Iressa(R)).

The Effect of ZD 1839 (Iressa(R)) in the Treatment of Refractory Non Small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study was to evaluate the efficacy and the safety of ZD 1839 (Iressa(R)) as a 3rd or 4th line chemotherapy regimen in NSCLC patients who are refractory to a previous chemotherapy regimen. MATERIALS AND METHODS: Twenty-five patients who were refractory to previous chemotherapy were selected for this study. The eligible patients had an ECOG performance status of 0 to 2, and an appropriate end organ function. ZD 1839 (Iressa(R))250 mg/d was orally administered until the patients experienced disease progression or unacceptable toxicity. RESULTS: Twenty-five patients were analyzed. The median age of the patients was 57 years. The response rate was 12.0% with partial responses in 3 patients. Fourteen patients (56%) remained in the stable disease state and 8 patients progressed. The median overall survival was 9.0 months (95% CI 6.7~11.2). The median progression free survival was 3 months (95% CI 2.2~3.8). Hematological toxicities of grade 3 or 4 neutropenia, anemia and thrombocytopenia were absent. Non-hematological toxicities were grade 2 or 3 skin rashes in 10 (40.0%) patients and 1 (4.0%) patient and grade 3 nausea in 3 (12.0%) patients. No patient failed to continue chemotherapy due to any drug-related adverse events. CONCLUSION: The results suggest that ZD 1839 (Iressa(R)) monotherapy is effective and tolerable as a 3rd or 4th line salvage treatment for NSCLC patients refractory to previous chemotherapy regimens.