Cutaneous Toxicity After Chemoradiotherapy and PD-L1 Inhibition in Two Patients with Esophageal Adenocarcinoma: More than Meets the Eye

Abstract

Dermatological adverse events have frequently been reported after immune checkpoint inhibition. When an adverse event occurs during combination of immune checkpoint inhibition with chemotherapy, the question arises which agent is responsible. Unnecessary withdrawal of either chemotherapy or immunotherapy could lead to suboptimal treatment outcomes. Here we report on two patients who developed a cutaneous drug reaction with fever during treatment with paclitaxel, carboplatin, radiotherapy, and PD-L1 inhibition (atezolizumab) for resectable esophageal adenocarcinoma. In the first case atezolizumab was suspected, and in the second paclitaxel. We discuss the clinical manifestation, treatment, and pathophysiology underlying both cases.

Trial registration: ClinicalTrials.gov NCT03087864.

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

© AlphaMed Press 2019.

Figures

Figure 1.

Treatment scheme in the PERFECT trial. Abbreviations: A, atezolizumab; C, carboplatin; P, paclitaxel; RT, radiotherapy; S, surgery.

Figure 2.

Erythema multiforme cutaneous reaction in the first case. (A): Erythematous plaques on the thorax. (B): Target lesions on the dorsum of the hands.

Figure 3.

Histopathologic evaluation of the two cases. (A): Extensive epidermal apoptosis consistent with an erythema multiforme‐like reaction in the first case. (B): Dermal infiltration with eosinophils (arrows) consistent with urticarial reaction in the second case.