Reporting on Adverse Clinical Events

A 79-year-old female patient developed localized skin lesions with itchy papules and vesicles on the cheek approximately 64 days after the initiation of afatinib for the treatment of metastatic non–small cell lung cancer. Concurrent medication included levothyroxine, cholecalciferol, valsartan, and nebivolol. Symptoms progressed to diffuse papules and vesicles, which evolved into atypical targetoid maculae on the trunk and eventually to flaccid bullae. Additional symptoms included oral ulcers, conjunctivitis, diffuse alopecia, and development of taste loss. Stevens-Johnson syndrome was diagnosed. Treatment included the discontinuation of afatinib and the administration of oral steroids (1 mg/kg/day), topical steroids, piperacillin/tazobactam, and desloratadine. Treatment was not successful in improving the patient’s condition. Serological testing for other causes was negative. A skin biopsy revealed acute interface dermatitis. Clinical symptoms and skin lesions slowly improved over a 20-day period with eventual recovery approximately 2 months after the drug was stopped. The authors concluded that this patient experienced Stevens-Johnson syndrome related to the administration of afatinib due to the temporal relationship between the administration of the drug and the appearance and resolution of symptoms. They cautioned clinicians to be aware of this potential adverse event associated with the drug. Afatinib [“Gilotrif”] Doesch J et al (W Brueckl, Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuernberg Prof.-Ernst-Nathan-Str 1, 90410 Nuremberg, Germany; e-mail: Wolfgang.brueckl@klinikum-nuernberg.de) Afatinib-associated Stevens-Johnson syndrome in an EGFR-mutated lung cancer patient. Lung Cancer 95:35–38 (May) 2016