[Pemetrexed-induced cutaneous sclerosis of the lower limbs]

Abstract

Background: Pemetrexed is an antifolate used to treat intrathoracic cancers. We report a rare case of cutaneous toxicity of pemetrexed with inflammatory cutaneous sclerosis of the lower limbs.

Patients and methods: A 63-year-old man diagnosed with metastatic adenocarcinoma of the lung was treated with pemetrexed. Fourteen months after undergoing this chemotherapy, he developed inflammatory and fibrotic edema of the lower limbs with functional consequences on knee bending. Cardiac, renal, hepatic, thrombotic and infectious causes were ruled out. Pemetrexed was suspended and partial remission was obtained using super-potent topical corticosteroids. With the approval of the oncologist, nivolumab was introduced as a follow-on therapy after pemetrexed.

Discussion: Often misdiagnosed by physicians, this form of toxicity due to pemetrexed is rare but classically described. To limit cutaneous side effects, dexamethasone may be proposed the day before, the same day as and the day after the infusion. Suspension of chemotherapy is not routine but depends on the risk-benefit ratio of the functional impact of the dermatosis and on the therapeutic alternatives available for the cancer.

Keywords: Inflammatory edema; Pemetrexed; Pémétrexed; Sclerosis; Sclérose; Skin toxicity; Toxicité cutanée; Œdèmes inflammatoires.