Letters 453
J AM ACAD DERMATOL VOLUME 47, NUMBER 3
Photoeruption in a patient treated with capecitabine (Xeloda) for metastatic breast cancer* To the Editor: We report a photoeruption in a patient with metastatic breast cancer 2 weeks after the administration of oral capecitabine chemotherapy, which, to our knowledge, has not been previously described in the literature. Capecitabine (Xeloda) is a novel, orally administered, tumor-selective fluoropyrimidine that is a prodrug of 5-fluorouracil; it was approved by the Food and Drug Administration in 1998 for the treatment of refractory metastatic breast cancer.1,2 A 56-year-old woman, seen on a regular basis in the dermatology clinic for actinic keratoses, actinic porokeratosis, benign papillomas, and basal cell carcinoma, presented with a pruritic eruption that began 2 weeks after the initiation of oral administration of capecitabine (1500 mg twice daily). In a photodistribution involving the upper trunk and upper extremities, there were multiple 0.5- to 1.5-cm pink macules, minimally elevated papules, and thin plaques, the majority of which had white scales. Lesions spared the face where foundation containing sunscreens (skin protection factor 15) had been applied on a daily basis. A biopsy specimen demonstrated interface change marked by basal vacuolar alteration and occasional necrotic keratinocytes. Focally enlarged keratinocytes with moderate atypia, consistent with a chemotherapy effect, were observed in the lower epidermis. The dermis showed a superficial and mid-dermal perivascular infiltrate of uniform lymphocytes. The patient was treated with loratadine, sunscreens, and topical halobetasol; administration of capecitabine was continued because *Funding source: None. Conflict of interest: None.
of the limited treatment options. Over the next 3 weeks, new lesions continued to appear, but the overall number of lesions decreased. The patient died before the initiation of a third 6-week course of capecitabine. To date, the following cutaneous adverse effects of capecitabine have been reported: palmar-plantar erythrodysesthesia,3 “dermatitis”,3 “erythematous rash,”3 “nail disorder,”1 and xerosis.4 Rare single occurrences of photosensitivity and radiation recall have been observed according to the manufacturer, but the details are unavailable (personal communication, Roche Laboratories, January 23, 2001).1 Several mucocutaneous reactions (eg, erythrodysesthesia and lichenoid and eczematous photoeruptions) have been reported in association with another oral prodrug of 5-fluorouracil, Tegafur, which has been used in Japan for more than 2 decades.5 Clinicians should become aware of the cutaneous reactions associated with capecitabine because its use is likely to increase, given the convenience and efficacy of this new drug. In addition, the pharmacokinetics of oral capecitabine are similar to those of continuous infusion 5-fluorouracil, which is associated with a greater incidence of cutaneous adverse effects.1 Whether photoeruptions will be seen more frequently in patients with significant photodamage remains to be determined. Andrea Willey, MDa Earl J. Glusac, MDa,b Jean L. Bolognia, MDa Departments of Dermatologya and Pathologyb Yale University School of Medicine New Haven, Connecticut Correspondence to: Andrea Willey, MD 30 Severance Circle 816 Cleveland Heights, OH 44118 E-mail:
[email protected] REFERENCES 1. Roche Laboratories Inc. Xeloda (capecitabine) prescribing information. U.S.A. 1998. 2. Macdonald J. Oral fluoropyrimidines: a closer look at their toxicities. Am J Clin Oncol 1999;22:475-80. 3. Blum J, Jones S, Buzdar A, LoRusso P, Kuter I, Vogel C, et al. Multicenter phase II study of capecitabine in paclitaxel-refractory metastatic breast cancer. J Clin Oncol 1999;2:485-93. 4. Cassidy J, Dirix L, Bissett D, Reigner B, Griffin T, Allman D, et al. A phase I study of capecitabine in combination with oral leucovorin in patients with intractable solid tumors. Clin Cancer Res 1998;4: 2755-61. 5. Horio T, Yokoyama M. Tegaful photosensitivity: lichenoid and eczematous types. Photodermatology 1986;3:192-3. 16/8/122745 doi:10.1067/mjd.2002.122745