Toxic epidermal necrolysis associated with apalutamide: a case report
and brief review of the literatures
Abstract
Apalutamide is a novel competitive inhibitor of the androgen receptor
for the treatment of non-metastatic castration-resistant prostate cancer
or metastatic castration-sensitive prostate cancer. Rash is the most
common skin adverse reaction of apalutamide. If rash is paid
insufficient attention, further developing life-threatening
Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis. Here, we reported
a case of toxic epidermal necrolysis caused by apalutamide. An
86-year-old male patient developed a Nikolsky-positive maculopapular
rash, skin exfoliation and mucosal erosion involving 60% body surface
area 24 days after treatment of oral apalutamide (180mg/d) for prostate
cancer with bone metastases. The skin manifestations aggravated after
discontinuation of apalutamide and treatment of methylprednisolone
(0.8mg/kg/d) and immunoglobulin (400mg/kg/d) for 2 days. Then, clinician
increased the dose of methylprednisolone and immunoglobulin. The skin
symptoms improved after treatment of methylprednisolone (1.2mg/kg/d) and
immunoglobulin (600mg/kg/d) for 5 days. This is the first to report a
dose-dependent response to methylprednisolone and immunoglobulin in the
treatment of apalutamide-caused toxic epidermal necrolysis. Since the
number of prostate cancer patients treated with apalutamide increases,
it is necessary to summarize and analyze the clinical characteristics
and treatment experience in cases of severe skin adverse reactions
caused by apalutamide.