Radiation recall dermatitis after docetaxel administration: absolute indication to replace the drug?

Abstract

Conflicts of interest: None to declare Sir, Docetaxel is a semisynthetic chemotherapeutic agent, belonging to the taxane family, which is used with increasing frequency in advanced and refractory ovarian, breast, lung, and head and neck cancers. Recent trials show significant activity also in prostate cancer, pancreatic and gastric carcinomas, extramammary Paget's disease and disseminated Kaposi sarcoma.1 Cutaneous reactions to docetaxel occur in approximately 50% of patients, including maculopapular exanthems, acral erythrodysaesthesia, scleroderma‐like fibrosis and nail changes;2, 3 interestingly, despite the wide use of the drug, only a few cases of radiation recall dermatitis (RRD) have been reported. On this topic, we report the case of a 63‐year‐old woman, affected by oestrogen‐negative, infiltrating ductal carcinoma of the left breast with involvement of homolateral axillary lymph nodes (T3N2). She underwent neo‐adjuvant chemotherapy with 5‐fluorouracil (Fluorouracile DBL®, Teva Pharma B.V., Mijdrecht, the Netherlands), epirubicin (Farmorubicina®, Pharmacia Italia, Milan, Italy) and cyclophosphamide (Endoxan Asta®, Baxter, Trieste, Italy) (six courses), and successive segmental mastectomy and lymph node dissection, that showed multiple lymphatic metastases (six of 12 axillary nodes). Because of resistance to prior anthracycline chemotherapy, radiotherapy was started, with a total dose of 5000 cGy in 5 weeks. One week after radiotherapy, adjuvant treatment with intravenous docetaxel (Taxotere®, Rhone Poulenc Rorer, Collegeville, PA, U.S.A.) was initiated (100 mg m−2 h−1 every 3 weeks). Four days after the second course, the patient developed an acute, painful erythematous reaction, classified as grade 1 using a scale based on the Radiation Therapy Oncology Group (RTOG) Acute Radiation Morbidity Criteria for skin,4 limited to the previously irradiated cutaneous area (Fig. 1). The diagnosis of RRD was made; treatment with oral methylprednisolone (16 mg day−1 for seven consecutive days) induced rapid (10 days), complete remission of the clinical features. On the basis of the mild cutaneous involvement, we decided, together with the oncologists, to continue docetaxel administration without modification of its dose. In order to reduce the probability of a recurrence of skin reactions, methylprednisolone (16 mg day−1 orally) was given for 5 days, starting the day before docetaxel infusion. No relapse of RRD was observed after seven courses of docetaxel.