A case of uremic pruritus and papulo-pustular rash associated with anti-EGFR therapy in a patient with rectal cancer and chronic kidney disease

封面
  • 作者: Michenko A.1,2,3,4, Kruglova L.1, Shatokhina E.1,2, Lvov A.1,2, Simenskaya E.1, Romanov D.3,5,6, Kononenko I.7, Snegovoy A.7
  • 隶属关系:
    1. Central State Medical Academy Department for Presidential Affairs of the Russian Federation
    2. Lomonosov Moscow State University, Medical Research and Educational Center
    3. International Institute of Psychosomatic Health
    4. Institute of Plastic Surgery and Cosmetology
    5. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
    6. Mental Health Research Center of the Russian Academy of Medical Sciences
    7. N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology ― branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation
  • 期: 卷 26, 编号 4 (2023)
  • 页面: 331-338
  • 栏目: DERMATO-ONCOLOGY
  • URL: https://journals.rcsi.science/1560-9588/article/view/132554
  • DOI: https://doi.org/10.17816/dv340919
  • ID: 132554

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详细

Uremic pruritus is a common symptom in chronic kidney disease and end-stage renal failure. In addition to physical discomfort uremic pruritus disrupts sleep, negatively affects the psycho-emotional state and quality of life. In this group of patients, the association of uremic pruritus with an increase in mortality due to any causes was demonstrated. At the same time, there are no standardized approaches to the treatment of uremic itching. There is also a special category of patients receiving antitumor therapy and developing dermatological adverse events, also potentially accompanied by itching.

This article presents a case of uremic pruritus in a patient with papulo-pustular cutaneous reaction (grade II on a Scale Common Terminology Criteria for Adverse Events, CTCAE v 5.0) to the epidermal growth factor (EGFR) inhibitor cetuximab in combination with leucovorin and 5-fluorouracil for rectal cancer. Treatment of uremic pruritus with small doses of gebapentin (300 mg/day) led to complete regression of pruritus. Papulo-pustular rashes completely regressed after recommended systemic and topical therapy according to the severity of rush (doxycycline 100 mg 2 times a day for 5 days, cream with neomycin, natamycin and hydrocortisone 3 times a day for 7 days). Pruritus was absent during the next 6 months of follow-up. Antitumor therapy was not interrupted due to acneiform rush, and following supportive topical therapy allowed to control severity of exacerbations which did not exceed I–II grade according to CTCAE v 5.0 and did not require the addition of systemic therapy.

Thus, therapy of uremic pruritus with gabapentin has shown was effective also in a patient with severe comorbid pathology. Supportive topical therapy consistent with the severity of papulo-pustular rash reduced the severity of exacerbations during following EGFR inhibitor therapy.

作者简介

Anna Michenko

Central State Medical Academy Department for Presidential Affairs of the Russian Federation; Lomonosov Moscow State University, Medical Research and Educational Center; International Institute of Psychosomatic Health; Institute of Plastic Surgery and Cosmetology

编辑信件的主要联系方式.
Email: amichenko@mail.ru
ORCID iD: 0000-0002-2985-5729
SPIN 代码: 8375-4620

MD, Cand. Sci. (Med.), Assistant Professor

俄罗斯联邦, Moscow; Moscow; Moscow; Moscow

Larisa Kruglova

Central State Medical Academy Department for Presidential Affairs of the Russian Federation

Email: kruglovals@mail.ru
ORCID iD: 0000-0002-5044-5265
SPIN 代码: 1107-4372

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Moscow

Evgeniya Shatokhina

Central State Medical Academy Department for Presidential Affairs of the Russian Federation; Lomonosov Moscow State University, Medical Research and Educational Center

Email: e.a.shatokhina@gmail.com
ORCID iD: 0000-0002-0238-6563
SPIN 代码: 3827-0100

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Moscow; Moscow

Andrey Lvov

Central State Medical Academy Department for Presidential Affairs of the Russian Federation;Lomonosov Moscow State University, Medical Research and Educational Center

Email: alvov@mail.ru
ORCID iD: 0000-0002-3875-4030
SPIN 代码: 1053-3290

MD, Dr. Sci. (Med.), Professor, Senior Research Associate

俄罗斯联邦, Moscow; Moscow

Ekaterina Simenskaya

Central State Medical Academy Department for Presidential Affairs of the Russian Federation

Email: skate779@mail.ru
ORCID iD: 0000-0002-1703-013X
SPIN 代码: 2554-5354
俄罗斯联邦, Moscow

Dmitry Romanov

International Institute of Psychosomatic Health; M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); Mental Health Research Center of the Russian Academy of Medical Sciences

Email: newt777@mail.ru
ORCID iD: 0000-0002-1822-8973
SPIN 代码: 2412-9077

MD, Dr. Sci. (Med.), Professor, Leading Researcher

俄罗斯联邦, Moscow; Moscow; Moscow

Inessa Kononenko

N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology ― branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation

Email: Inessa.Kononenko@mail.ru
ORCID iD: 0000-0002-7142-2986
SPIN 代码: 8306-1365

MD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow

Anton Snegovoy

N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology ― branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation

Email: drsneg@gmail.com
ORCID iD: 0000-0002-0170-5681
SPIN 代码: 8398-2396

MD, Dr. Sci. (Med.)

俄罗斯联邦, Moscow

参考

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  3. Urbonas A, Schwartz RA, Szepietowski JC. Uremic pruritus: An update. Am J Nephrol. 2001;21(5):343–350. doi: 10.1159/000046272
  4. Volkov MM, Dobronravov BA. Uremic itching in patients on renal replacement therapy (program of continuous postgraduate education in nephrology). Nephrology. 2006;10(2):110–117. (In Russ).
  5. Mettang T. Uremic itch management. Curr Probl Dermatol. 2016;(50):133–141. doi: 10.1159/000446056
  6. Lau T, Leung S, Lau W. Gabapentin for uremic pruritus in hemodialysis patients: A qualitative systematic review. Can J Kidney Health Dis. 2016;(3):14. doi: 10.1186/s40697-016-0107-8
  7. Weisshaar E, Matterne U, Mettang T. How do nephrologists in haemodialysis units consider the symptom of itch? Results of a survey in Germany. Nephrol Dial Transplant. 2009;24(4):1328–1330. doi: 10.1093/ndt/gfn769
  8. Simonsen E, Komenda P, Lerner B, et al. Treatment of uremic pruritus: A systematic review. Am J Kidney Dis. 2017;70(5):638–655. doi: 10.1053/j.ajkd.2017.05.018
  9. Koroleva IA, Bolotina LV, Gladkov OA, et al. Practical recommendations for the drug treatment of dermatological reactions in patients receiving antitumor drug therapy. Malignant tumors. 2022;12(3S2-2):101–122. (In Russ). doi: 10.18027/2224-5057-2022-12-3s2-101-122
  10. Lacouture ME, Sibaud V, Gerber PA, et al.; ESMO Guidelines Committee. Prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines. Ann Oncol. 2021;32(2):157–170. doi: 10.1016/j.annonc.2020.11.005
  11. Shatokhina EA, Kruglova LS, Polonskaya AS, Nosikova PG. Acne-like rash: A dermatological undesirable phenomenon of therapy with monoclonal antibodies to EGFR. Pharmateca. 2020;27(8):56–60. (In Russ). doi: 10.18565/pharmateca.2020.8.56-60
  12. Shatokhina EA, Kruglova LS, Polonskaya AS. Treatment of acne-like rash induced by monoclonal antibodies to the epidermal growth factor receptor (EGFR). Medical Council. 2020;(20):157–164. doi: 10.21518/2079-701X-2020-20-157-164

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2. Fig. 1. Patient, 76 years old, with uremic pruritus: Diffuse grayish pigmentation due to chronic friction is visible on the skin of the shoulders and supra-scapular areas. In the upper third of the back there are multiple solar lentigos, few seborrheic keratoses and melanocytic nevi.

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3. Fig. 2. The same patient. Evolution of papulo-pustular skin toxic reaction: before treatment (a, b) and 2 weeks after the start of therapy (c, d).

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版权所有 © Michenko A.V., Kruglova L.S., Shatokhina E.A., Lvov A.N., Simenskaya E.M., Romanov D.V., Kononenko I.B., Snegovoy A.V., 2023

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