Reactions Weekly | 2021
Capecitabine/docetaxel/pembrolizumab
Abstract
Cutaneous toxicity, lack of efficacy and hand-foot syndrome due to drug toxicity: case report A 70-year-old man developed cutaneous toxicity during treatment with docetaxel for porocarcinoma. Subsequently, he exhibited lack of efficacy during treatment with pembrolizumab and developed hand-foot syndrome due to drug toxicity during treatment with capecitabine for porocarcinoma [routes, durations of treatments to reactions onsets and outcomes not stated]. The man underwent excision of a skin lesion localised in the right scapula area in June 2017. The histological examination showed a dermo-epidermal localisation of poorly differentiated epithelial malignant neoplasm with squamoid features. A CT scan performed in July 2017 revealed bulky right axillary lymphadenopathy. Therefore, in September 2017, he underwent complete right axillary lymphadenectomy and histological examination was compatible with a porocarcinoma. After the surgery, he started receiving adjuvant chemotherapy with docetaxel 35 mg/mq/week. Thereafter, he developed cutaneous toxicity due to docetaxel. Therefore, the man’s docetaxel therapy was discontinued after seven doses. In November 2018 and April 2019, he underwent surgical excision of local skin relapse. Later, the disease metastatised with multi-organ involvement (bone, skin and lung). Therefore, between October 2019 and December 2019, he received pembrolizumab 200mg flat dose every 3 weeks. However, pembrolizumab therapy failed to halt the disease progression (lack of efficacy). A total body CT scan performed in January 2020 showed further disease progression. Then, he received cetuximab along with metronomic dose of capecitabine 500mg twice daily for seven total doses, with clinical benefit and radiological response. However, due to severe hand-foot syndrome with local superinfection likely due to capecitabine toxicity, the treatment was stopped in June 2020. He died on the 30 August 2020 after a rapid worsening of clinical conditions [cause of death not clearly stated].