Vol 15, No 6 (2019)
Case report
Published online: 2020-01-10

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Short bowel syndrome and severe skin toxicity as a complication of FOLFOX chemotherapy with panitumumab in a patient with colorectal cancer — a case report

Kinga Krawiec1, Sylwia Dębska-Szmich2, Urszula Czernek2, Rafał Czyżykowski2, Piotr Potemski2
Oncol Clin Pract 2019;15(6):326-330.

Abstract

The combination of monoclonal antibodies targeting epidermal growth factor receptor (EGFR) with chemotherapy is the standard treatment in advanced colorectal cancer without mutations in the RAS and BRAF genes. We present a case of a 55-year-old female patient with unacceptable skin toxicity and short bowel syndrome caused by palliative FOLFOX chemotherapy combined with panitumumab. In 2012, after the emergence of an artificial anus due to gastrointestinal obstruction in the course of rectal cancer, the patient underwent inductive chemotherapy, preoperative chemoradiotherapy, and radical surgery. Tubular adenocarcinoma G2, ypT2N0 was diagnosed. In 2013 and 2015 she underwent two additional surgeries including intestinal resection due to obstruction of the gastrointestinal tract and enterovaginal fistula. In February 2018 she was qualified for palliative chemotherapy because of inoperable relapse. Due to very good performance status (PS0) and absence of mutations of RAS and BRAF genes, regardless of being underweight and suffering from loose stools persisting from the time of surgery, FOLFOX chemotherapy with panitumumab was introduced. After the second administration of drugs an acne-like rash, hand-foot syndrome, and diarrhoea appeared. Intensification of symptoms and manifestations of short bowel syndrome were observed afterwards. Topical treatment of skin lesions, doxycycline, and anti-diarrhoeal therapy were introduced, with a mediocre therapeutic effect. Imaging confirmed disease stabilisation, but due to the deterioration of both performance status and life quality, anti-cancer treatment was discontinued. This case draws attention to the necessity of caution while qualifying for potentially toxic combination chemotherapy.

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References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
  2. Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2016, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site, April 2019.
  3. Xie MZ, Li JL, Cai ZM, et al. Impact of primary colorectal Cancer location on the KRAS status and its prognostic value. BMC Gastroenterol. 2019; 19(1): 46.
  4. Zhao B, Wang Lu, Qiu H, et al. Mechanisms of resistance to anti-EGFR therapy in colorectal cancer. Oncotarget. 2017; 8(3): 3980–4000.
  5. Tran B, Kopetz S, Tie J, et al. Impact of BRAF mutation and microsatellite instability on the pattern of metastatic spread and prognosis in metastatic colorectal cancer. Cancer. 2011; 117(20): 4623–4632.
  6. Price TJ, Peeters M, Kim TW, et al. Panitumumab versus cetuximab in patients with chemotherapy-refractory wild-type KRAS exon 2 metastatic colorectal cancer (ASPECCT): a randomised, multicentre, open-label, non-inferiority phase 3 study. Lancet Oncol. 2014; 15(6): 569–579.
  7. Jonker DJ, Karapetis CS, Harbison C, et al. K-ras mutations and benefit from cetuximab in advanced colorectal cancer. N Engl J Med. 2008; 359(17): 1757–1765.
  8. Douillard JY, Oliner KS, Siena S, et al. Panitumumab-FOLFOX4 treatment and RAS mutations in colorectal cancer. N Engl J Med. 2013; 369(11): 1023–1034.
  9. Cutsem EV, Lenz HJ, Köhne CH, et al. Fluorouracil, Leucovorin, and Irinotecan Plus Cetuximab Treatment andRASMutations in Colorectal Cancer. J Clin Oncol. 2015; 33(7): 692–700.
  10. Jost M, Kari C, Rodeck U. The EGF receptor — an essential regulator of multiple epidermal functions. Eur J Dermatol. 2000; 10(7): 505–510.
  11. Siena S, Tabernero J, Bodoky G, et al. Quality of life during first-line FOLFOX4 ± panitumumab in wild-type metastatic colorectal carcinoma: results from a randomised controlled trial. ESMO Open. 2016; 1(2): e000041.
  12. Douillard JY, Siena S, Cassidy J, et al. Final results from PRIME: randomized phase III study of panitumumab with FOLFOX4 for first-line treatment of metastatic colorectal cancer. Ann Oncol. 2014; 25(7): 1346–1355.
  13. Saltz LB, Meropol NJ, Loehrer PJ, et al. Phase II trial of cetuximab in patients with refractory colorectal cancer that expresses the epidermal growth factor receptor. J Clin Oncol. 2004; 22(7): 1201–1208.
  14. Douillard JY, Rong A, Sidhu R. RAS mutations in colorectal cancer. N Engl J Med. 2013; 369(22): 2159–2160.
  15. Kowalska M, Kowalik A, Góźdź S. Dermatologic adverse events associated with chemotherapy and targeted anticancer therapy. Przegląd Dermatologiczny. 2016; 2: 127–138.
  16. Ocvirk J, Heeger S, McCloud P, et al. A review of the treatment options for skin rash induced by EGFR-targeted therapies: Evidence from randomized clinical trials and a meta-analysis. Radiol Oncol. 2013; 47(2): 166–175.
  17. Lacouture ME, Mitchell EP, Piperdi B, et al. Skin toxicity evaluation protocol with panitumumab (STEPP), a phase II, open-label, randomized trial evaluating the impact of a pre-Emptive Skin treatment regimen on skin toxicities and quality of life in patients with metastatic colorectal cancer. J Clin Oncol. 2010; 28(8): 1351–1357.
  18. Pironi L, Arends J, Bozzetti F, et al. Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN, Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr. 2016; 35(2): 247–307.
  19. Arends J, Baracos V, Bertz H, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017; 36(5): 1187–1196.
  20. Bozzetti F, Arends J, Lundholm K, et al. ESPEN guidelines on parenteral nutrition: non-surgical oncology. Clinical Nutrition. 2009; 28(4): 445–454.