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Indian Pediatr 2013;50: 430 |
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Gemcitabine Induced Skin Rash
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Vikas Dua and *Hari Goyal
Department of Pediatric Hematology Oncology and
*Medical Oncology, Action Cancer Hospital, Delhi, India.
Email: [email protected]
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Gemcitabine is used in various carcinomas
like lung cancer, pancreatic cancer, bladder cancer and
breast cancer in adults. It is considered to be a
well-tolerated drug with little known side effects [1]. The
reported toxic effects of gemcitabine include
myelosuppression, altered liver function tests, flu–like
syndrome, bronchospasm, rash, itching, and fever [2]. Skin
reactions are rarely reported [1-4], the reported incidence
being 7%–30% [4].
Gemcitabine has not been frequently used
in pediatric malignancies and to our knowledge there is only
one paper describing skin rash in children with the use of
gemcitabine [5]. A 8-year-old boy was admitted in our
hospital because of fever and multiple swellings on both
sides of his neck in March 2012. On examination, multiple
bilateral cervical lymph nodes were palpable. Abdominal
examination showed hepatosplenomegaly and rest of the
systemic examination was normal. Biopsy of cervical lymph
node suggested Hodgkin’s disease. Diagnosed as stage III B
Hodgkin’s disease, he was treated with adriamycin, bleomycin,
vinblastine and dacarbazine (ABVD) based chemotherapy.
Re-evaluation following 4 cycles of chemotherapy revealed
progressive disease, so patient was put on ifosfamide,
gemcitabine, vinorelbine and prednisolone (IGV) based
chemotherapy. Gemcitabine 800 mg/m 2
was given on days 1 and 4, vinorelbine 20/m2
mg on day 1, ifosfamide 2000 mg/m2
on day 1 to 4 and Prednisolone 2mg/kg
from Day 1 to 4 of each 21-day cycle. On Day 3 of treatment
child developed a maculopapular, itchy skin rash. The rashes
involved the neck, chest, back, upper arms and abdominal
wall. It subsided in severity within 4-5 days with the use
of oral antihistamine. However, it reappeared again on day 5
on repeat challenge with gemcitabine during second cycle of
chemotherapy. The skin lesions were again easily managed
with oral antihistamines.
The other drugs being used in this child
also cause skin rash and the possibility of this reaction
due to them, or additive effect of all the drugs cannot be
ruled out. Dermatologic side effects of vinorelbine
including alopecia (12%), rash (<5%), pruritus, blister
formation, skin sloughing, and urticaria have been reported
and with ifosfamide, even rare (affect between 1 in 1000 and
1 in 10,000 people) includes rash and dermatitis. The causal
relationship of gemcitabine treatment with skin reaction is
probable in our case according to the Naranjo probability
scale.
References
1. Imen A, Amal K, Ines Z, Sameh el F,
Fethi el M, Habib G. Bullous dermatosis associated with
gemcitabine therapy for non-small-cell lung carcinoma.
Respir Med. 2006;100:1463-5.
2. Kuku I, Kaya E, Sevinc A, Aydogdu I.
Gemcitabine-induced erysipeloid skin lesions in a patient
with malignant mesothelioma. J Eur Acad Dermatol Venereol.
2002; 16:271-2.
3. Chen YM, Liu JM, Tsai CM, Whang-Peng
J, Perng RP. Maculopapular rashes secondary to gemcitabine
injection for non-small-cell lung cancer. J Clin Oncol.
1996;14: 1743-4.
4. Kanai M, Matsumoto S, Nishimura T,
Matsumura Y, Hatano E, Mori A, et al. Premedication
with 20 mg dexamethasone effectively prevents relapse of
extensive skin rash associated with gemcitabine monotherapy.
Ann Oncol. 2010; 21:189-90.
5. Reid JM, Qu W, Safgren SL, Ames MM, Krailo MD, Seibel
NL, et al. Phase I trial and pharmacokinetics of
gemcitabine in children with advanced solid tumors. J Clin
Oncol. 2004;22:2445-51.
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