Trastuzumab induced radiation recall dermatitis: an interesting case

Radiation recall dermatitis (RRD) is the appearance of skin reactions in previously irradiated skin which is triggered by the administration of certain drugs. Surgery, chemotherapy, and radiotherapy are the mainstay of treatment in breast cancer. RRD induced by trastuzumab has been rarely reported in India. This is a case report of a 56-year-old woman presented to the medical oncology outpatient department of our hospital with breast lump, and she was diagnosed to have human epidermal growth factor receptor 2 (HER-2/neu) positive invasive ductal carcinoma of left breast of stage T2N3cM0. She was treated with neoadjuvant chemotherapy, and she underwent modified radical mastectomy with axillary lymph node dissection. The treating oncologist was planned to start on adjuvant chemotherapy with injection trastuzumab for every four weeks, for 15 cycles. Patient received first dose of injection trastuzumab (450 mg) intravenously in the right (contralateral) arm and developed painful, swollen, erythematous blisters, and maculopapular rashes following the sharp linear borders of her previous radiation fields. She was reviewed by the medical oncologist and diagnosed as a rare case of RRD and treated with topical betamethasone cream. Causality assessment for RRD to trastuzumab was done using Naranjo and WHO-UMC scale and found to be in the category of probable and probable/ likely respectively.

Radiation recall dermatitis triggered by sorafenib after radiation therapy for hepatocellular carcinoma

Sorafenib is widely used for unresectable and metastatic hepatocellular carcinomas. Radiation recall dermatitis (RRD) is an acute inflammatory reaction confined to previously irradiated skin that occurs after the administration of certain drugs. RRD after sorafenib treatment is rare; five cases have been reported thus far. We describe a 44-year-old man irradiated for chest wall bone metastasis from hepatocellular carcinoma. Eight days after radiotherapy completion, systemic therapy for metastatic hepatocellular carcinoma was initiated with sorafenib treatment. Eleven days after starting sorafenib, the patient complained of erythematous rash with pruritus in the chest wall, in a location consistent with the previous radiation field. Sorafenib was continued at the same dose, despite the RRD. The skin reaction subsided over the next 2 weeks without any medical intervention.

Radiation recall dermatitis triggered by sorafenib after radiation therapy for hepatocellular carcinoma

Sorafenib is widely used for unresectable and metastatic hepatocellular carcinomas. Radiation recall dermatitis (RRD) is an acute inflammatory reaction confined to previously irradiated skin that occurs after the administration of certain drugs. RRD after sorafenib treatment is rare; five cases have been reported thus far. We describe a 44-year-old man irradiated for chest wall bone metastasis from hepatocellular carcinoma. Eight days after radiotherapy completion, systemic therapy for metastatic hepatocellular carcinoma was initiated with sorafenib treatment. Eleven days after starting sorafenib, the patient complained of erythematous rash with pruritus in the chest wall, in a location consistent with the previous radiation field. Sorafenib was continued at the same dose, despite the RRD. The skin reaction subsided over the next 2 weeks without any medical intervention.

Reacción evocadora de radiación por trastuzumab: revisión y reporte de un caso / Radiation recall dermatitis induced by trastuzumab: review and case report

Se presenta un caso de reacción evocadora de radiación (RER) en una paciente de 37 años con cáncer de mama estadio IIIB, que realizó 6 ciclos de quimioterapia con epidoxorubicina y docetaxel, terapia radiante y trastuzumab. Diez días después definalizada la radioterapia, desarrolló una dermatosis ampollar en la mama irradiada, coincidiendo con un ciclo de tratuzumab. El trastuzumab, anticuerpo monoclonal humanizado contra el receptor HER2, fue aprobado en 1998 por la FDA como primera línea de tratamiento paliativo para el cáncer de mama avanzado con receptores HER2 positivos y, como terapia adyuvante, en 2006. Existen pocos casos de RER por trastuzumab comunicados hasta la fecha.

A 37-year-old female patient with radiation recall dermatitis (RRD) is reported. She held 6 cycles of chemotherapy with epidoxorubicin and docetaxel, radiant therapy and trastuzumab due to stage IIIB breast cancer. Ten days after finishing radiation therapy, she developed a blistering dermatitis on irradiated breast. Trastuzumab, a humanized monoclonal antibody against the HER2 receptor, was approved in 1998 by the FDA as a first-line palliative treatment for advanced breast cancer with positive HER2 receptors and, as adjuvant therapy, in 2006. There are only few cases reported of RRD by trastuzumab up to date.

Radiation recall dermatitis induced by tamoxifen during adjuvant breast cancer treatment

Tamoxifen and radiotherapy are used in breast cancer treatment worldwide. Radiation recall dermatitis (RRD), induced by tamoxifen, has been rarely reported. Herein, we report a RRD case induced by tamoxifen. A 47-year-old woman had a right quadrantectomy and an axillary lymph node dissection due to breast cancer. The tumor was staged pT2N0; it was hormone receptor positive, and human epidermal growth factor receptor 2 negative. The patient received adjuvant chemotherapy followed by tamoxifen and radiotherapy. After 22 months of tamoxifen, the patient developed a localized heating sensation, tenderness, edema, and redness at the irradiated area of the right breast. The symptoms improved within 1 week without treatment. Three weeks later, however, the patient developed similar symptoms in the same area of the breast. She continued tamoxifen before and during dermatitis, and symptoms resolved within 1 week.

Radiation Recall Dermatitis Induced by Gefitinib / 이화의대지

Radiation recall dermatitis refers to an acute inflammatory reaction in a previously irradiated field triggered by the administration of certain drugs days to years after the exposure to radiation. Gefitinib is an epidermal growth factor receptor tyrosine kinase inhibitor and is an effective treatment for patients with advanced stage of non small cell lung cancer (NSCLC). Here, we report a rare case of gefitinib induced radiation recall dermatitis. A 52-year-old woman with a metastatic NSCLC had received a palliative radiation therapy of 20 cGy on spine metastasis area (C6-T6). After 24 days of receiving radiation therapy, she had started to take gefitinib. Eight months after taking drug, pain, swelling and erythema of skin were occurred on previously irradiated field. These symptoms were resolved after the cessation of gefitinib for 6 days and the topical use of steroid.

Radiation Recall Dermatitis Induced by Gefitinib / 이화의대지

Radiation recall dermatitis refers to an acute inflammatory reaction in a previously irradiated field triggered by the administration of certain drugs days to years after the exposure to radiation. Gefitinib is an epidermal growth factor receptor tyrosine kinase inhibitor and is an effective treatment for patients with advanced stage of non small cell lung cancer (NSCLC). Here, we report a rare case of gefitinib induced radiation recall dermatitis. A 52-year-old woman with a metastatic NSCLC had received a palliative radiation therapy of 20 cGy on spine metastasis area (C6-T6). After 24 days of receiving radiation therapy, she had started to take gefitinib. Eight months after taking drug, pain, swelling and erythema of skin were occurred on previously irradiated field. These symptoms were resolved after the cessation of gefitinib for 6 days and the topical use of steroid.

Sorafenib-triggered radiation recall dermatitis with a disseminated exanthematous reaction

Sorafenib is a multi-targeted kinase inhibitor, which is the current standard treatment for advanced hepatocellular carcinoma (HCC). Only one case of radiation recall dermatitis (RRD) associated with sorafenib has been reported so far. Our patient with recurrent HCC was treated with palliative radiotherapy (RT) for the chest wall mass. Sorafenib at 400 mg twice daily was begun on the day following RT. On the 14th day post-RT, an erythematous patch was observed on right chest wall which matched area previously irradiated. It was consistent with RRD. Ten days later, a disseminated exanthematous rash and severe pruritus occurred. Sorafenib was stopped and an oral antihistamine was prescribed to relieve symptoms. At the 1-week follow-up after the cessation of sorafenib, all symptoms were resolved. Physicians should be alert to this recall phenomenon as it can occur both in the skin and elsewhere and the occurrence of RRD may be unpredictable.

Erlotinib HCL (Tarceva(R)) Induced Radiation Recall Dermatitis / 대한피부과학회지

Erlotinib (Tarceva(R)) is a new anti-cancer agent that acts by inhibiting epidermal growth factor receptor (EGFR) signal transduction. It is currently used in the treatment of advanced stage non-small cell lung cancer and pancreatic cancer. A patient consulted our clinic and she had erythematous patches and vesicles on the submandibular area. She had taken erlotinib for the treatment of recurred lung cancer for 2 weeks. We report here on a case of radiation recall dermatitis that was induced by erlotinib in a 69-year-old woman who was previously irradiated on her submandibular area.

Radiation Recall Dermatitis Induced by Methotrexate / 대한피부과학회지

Radiation recall dermatitis is the development of an inflammatory reaction in the previously irradiated area, precipitated by the administration of certain drugs. A 54-year-old man was diagnosed with follicular lymphoma, grade 3 and stage 3. Cancer recurred two years after complete remission obtained by chemotherapy and radiotherapy. Therefore, he was again treated with fludarabine and mitoxantrone for five cycles, then underwent an allogeneic peripheral blood stem cell transplantation (PBSCT). The patient started to receive methotrexate the day after PBSCT. On the day of the first methotrexate administration, the patient developed erythematous erosions with pruritus and severe pain in the previously irradiated area. The skin lesion resolved almost completely after dressing with topical antibiotics and wet dressing with 0.3% aluminium solution for 2 weeks. We report a case of radiation recall dermatitis in a patient with follicular lymphoma that occurred after receiving methotrexate.

A Case of Radiation Recall Dermatitis / 대한피부과학회지

Radiation recall dermatitis is the development of an inflammatory reaction throughout an area previously irradiated, precipitated by the administration of certain drugs. A 48-year-old woman was postoperatively treated with radiotherapy for synovial sarcoma on her left hip. The total dose given was 46 Gy by 2 Gy per day. After 2 weeks, she underwent her 1st cyclophosphamide, dacarbazine, doxorubicin (MAID) chemotherapy teatment. After 3 days, erythema began to develop in the previously irradiated area and during the following 7 days a severe skin and subcutaneous reaction occurred. After 3 weeks, the skin lesion was completely healed and thereafter no further "recall" occurred despite a 2nd MAID chemotherapy treatment.

A Case of Radiation Recall Dermatitis after Hormonal Therapy of Letrozol (Femara(R)) / 대한피부과학회지

Radiation recall dermatitis gap (RRD) is the development of an inflammatory reaction throughout a previously irradiated area, precipitated by the administration of certain drugs. Usually chemotherapeutic agents have been associated with RRD, but other drugs reported include tamoxifen, interferon alfa-2b, simvastatin, and antituberculous drugs. We present a case of RRD after chemotherapy with letrozol (Femara(R)). Letrozol is a third generation aromatase inhibitor, which acts as an anti-estrogen agent. This is the first reported case of RRD triggered by letrozol.

A Case of Radiation Recall Dermatitis which Developed in a Patient with Kaposi Sarcoma / 대한피부과학회지

Radiation recall dermatitis is a rare skin reaction, occurring subsequent to drug administration, and has all the clinical signs of inflammation, which develop in a previously irradiated area, days to years after exposure to ionizing radiation. A 41-year-old woman was diagnosed with Kaposi sarcoma. The patient was treated by radiotherapy, followed by a 1st chemotherapy session with doxorubicin and ifosfamide, 20 days after the radiotherapy. However, the patient developed erythema of the skin, accompanied by pruritus and pain in the previously irradiated area, 3 to 4 days after the chemotherapy. The erythema resolved almost completely after systemic and topical steroid therapy. The patient received a 2nd chemotherapy session with the same regimen, but there was no recurrence of radiation recall dermatitis. We report a case of an uncommon skin reaction after chemotherapy in a patient with kaposi sarcoma, which was identified as radiation recall dermatitis.

A Case of Radiation Recall Dermatitis which Developed in a Patient with Kaposi Sarcoma / 대한피부과학회지

Radiation recall dermatitis is a rare skin reaction, occurring subsequent to drug administration, and has all the clinical signs of inflammation, which develop in a previously irradiated area, days to years after exposure to ionizing radiation. A 41-year-old woman was diagnosed with Kaposi sarcoma. The patient was treated by radiotherapy, followed by a 1st chemotherapy session with doxorubicin and ifosfamide, 20 days after the radiotherapy. However, the patient developed erythema of the skin, accompanied by pruritus and pain in the previously irradiated area, 3 to 4 days after the chemotherapy. The erythema resolved almost completely after systemic and topical steroid therapy. The patient received a 2nd chemotherapy session with the same regimen, but there was no recurrence of radiation recall dermatitis. We report a case of an uncommon skin reaction after chemotherapy in a patient with kaposi sarcoma, which was identified as radiation recall dermatitis.

Drug induced radiation recall dermatitis / 中国癌症杂志

Multiple modality treatment has been adapted for the treatment of various cancers,the outcome has been dramatically improved,but some of unique side effects due to the modalities like chemotherapy combined with radiotherapy have been observed in the clinic. Radiation recall dermatitis(RRD) is one of the side effects. In this paper,the etiology,clinical features,diagnosis,treatment and related factors of the radiation recall dermatitis are discussed.