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- Presentation
Severe Cutaneous Adverse Reaction Due to Nectin-4 Targeted Cancer Therapy
Description
The presentation discusses a case of severe cutaneous adverse reaction in a 66-year-old male patient undergoing treatment for high-grade urothelial carcinoma with enfortimab vedotin and pembrolizumab. Initially admitted for fever and rash, the patient exhibited extensive erythroderma with targetoid papules, genital ulcers, and deeper tissue ulcerations. After two cycles of treatment, he developed a severe rash affecting over 90% of his body surface area and acute kidney injury, leading to hospitalization. Histopathological examination indicated a toxic epidermal necrolysis (TEN)-like condition linked to enfortimab vedotin, a microtubule disruptor targeting Nectin-4. This drug showed promising results but was associated with high rates of cutaneous toxicities, including severe eruptions and ulcerations. Management included stopping the offending medications, initiating high-dose corticosteroids, and considering rifampin to aid in drug clearance. The patient showed significant improvement after aggressive treatment and was discharged with a tapering regimen. Notably, he achieved radiographic clearance of his tumor and did not require additional therapy initially; however, he was later monitored for potential recurrence. The presenters emphasize the importance of recognizing and managing severe skin reactions in patients receiving targeted cancer therapies.
View moreConclusions
- Severe cutaneous adverse reactions can occur with enfortumab vedotin, particularly in patients with high-grade urothelial carcinoma.
- The reported patient experienced a severe rash resembling toxic epidermal necrolysis after treatment with enfortumab vedotin and pembrolizumab.
- Enfortumab vedotin is associated with frequent cutaneous toxicity, with over 30% of patients experiencing adverse skin effects.
- Common skin reactions to enfortumab vedotin include pruritus, maculopapular rashes, and significant peeling or flaking.
- Histopathological evaluation in the reported case indicated features consistent with Stevens-Johnson syndrome/toxic epidermal necrolysis.
- Differential diagnoses for severe skin reactions during treatment with enfortumab should include toxic epidermal necrolysis and progressive immunotherapy-related mucocutaneous eruption.
- Management of enfortumab-related cutaneous reactions involves cessation of the drug, supportive care, and corticosteroid therapy.
- Patient outcome was favorable with resolution of skin symptoms after treatment adjustment and pharmacologic interventions, without the need for further cancer therapy at that time.
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