Delayed Photosensitivity Dermatitis Caused by Crizotinib

Crizotinib is used as first-line treatment for anaplastic lymphoma kinase (ALK)-positive advanced lung adenocarcinoma. Commonly reported toxicities include visual disturbance, diarrhea, transaminitis, fatigue, and edema. In phase I and phase III trials of crizotinib, rashes were reported in patients at frequencies of 11% and 9%, respectively. Most of these patients developed a skin rash (photosensitivity dermatitis) just after taking crizotinib or within 1 to 2 months thereafter. The patient reported here developed delayed photosensitivity dermatitis after taking crizotinib for 6 months. The patient's rash was likely caused by crizotinib, since it persisted when other medications were discontinued, but resolved after crizotinib was held. The rash flared up again after re-challenging. The skin rash was characterized by itchy plaques on the 4 extremities, classified as grade II. Skin biopsy was performed and the pathological finding was compatible with drug-related photosensitivity dermatitis. After the dosage of crizotinib was adjusted, the patient's skin rash became less severe, and was tolerable. It is unusual for patients taking crizotinib to develop delayed photosensitivity. The associated etiologies remain uncertain and may be mediated by ALK inhibition itself, an off-target effect, or by host immunity to crizotinib.

關鍵字

crizotinib ； photosensitivity dermatitis ； ALK-positive lung cancer

並列摘要

截剋瘤（Crizotinib）是目前末期肺癌中為治療間變性淋巴瘤激酶（ALK）陽性的第一線藥物，然而這種藥物最常被提出的副作用包含視覺障礙、腹瀉、轉胺酶增加、疲倦和水腫。在第一期和第三期臨床試驗中，約有9%至11%的病人會在藥物使用的一到兩個月內出現皮疹（光敏感性皮膚炎）的情況。我們所提供的這個案例是在使用藥物約六個月之後才開始出現皮疹，而皮疹在停用其他藥物之後仍持續存在並且在停用截剋瘤的之後才獲得改善，而當再度使用截剋瘤之後皮疹復發。這些皮疹主要以在四肢出現二級騷癢性丘疹為表現。這些病情變化表示皮疹極可能是截剋瘤所造成。在調低藥物劑量之後，病人皮疹的狀況亦有減輕並且可以忍受的情況。此延遲光敏感性皮膚炎的情況在這類病人之中並不常見，相關的病因機轉目前仍不清楚，或許和藥物本身有關，或許是非目標基因（off target effect）的效果或是宿主免疫系統對截剋瘤所產生的反應。

並列關鍵字

截剋瘤Crizotinib ；光敏感性皮膚炎；間變性淋巴瘤激酶陽性肺癌ALK

國際替代計量

Delayed Photosensitivity Dermatitis Caused by Crizotinib

全文下載

主題瀏覽