Neoadjuvant Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

kinase (ITK), epidermal growth factor receptor kinase, and T-cell X chromosome kinase, which likely explains adverse effects not related to BTK inhibition alone. ITK functions downstream of the T‐cell receptor, playing a central role in inflammatory responses and T‐cell maturation. Thus, ibrutinib predisposes patients to viral and opportunistic infections.3 Another hypothesis that explains the high predisposition to skin and soft-tissue infections is that BTK inhibitors reduce neutrophil chemotaxis into these peripheral tissues, and despite having normal neutrophil counts, infections such as cellulitis are seen at a higher than normal rate in patients on these drugs. Skin rash is also known to occur in 20%–25% patients and is usually at a grade 1 or 2, not requiring dose interruption or reduction.4 Two case reports of grade 3 cellulitis have been published.5Deep seated infections such as osteomyelitis are not yet reported with this therapy, and this patient’s progression from cellulitis to hemorrhagic cellulitis and culminating in osteomyelitis of metacarpal bone seems to be the first of its kind. This case highlights the importance of consideration of osteomyelitis in patients developing cellulitis with ibrutinib that are not responding appropriately to antibiotics to recognize and treat the condition promptly. As the use of ibrutinib grows, longitudinal recording and reporting of adverse events will help with early recognition and intervention for less common but clinically important adverse effects. Ajay Tambe, MBBS Wajihuddin Syed, MBBS Muhammad Naqvi, MD Vikrant Tambe, MBBS Rachana Mandru, MBBS Departments of Internal Medicine Hematology/Oncology, SUNY Upstate Medical University, Syracuse, NY