Combination therapy(toripalimab and lenvatinib)-associated toxic epidermal necrolysis in a patient with metastatic liver cancer:A case report  

作　　者：Kai-Kai Huang Shan-Shan Han Li-Ya He Lin-Lin Yang Bao-Ying Liang Qing-Yu Zhen Zi-Bo Zhu Cai-Yun Zhang Hong-Yi Li Ying Lin 

机构地区：[1]Department of Dermatology,the Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120,Guangdong Province,China [2]Department of Dermatology,the Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510120,Guangdong Province,China [3]Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases,Guangzhou 510120,Guangdong Province,China

出　　处：《World Journal of Clinical Cases》2022年第11期3478-3484,共7页世界临床病例杂志

基　　金：Supported by Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases,No. 2018B030322012

摘　　要：BACKGROUND Both programmed cell death-1(PD-1)inhibitors and lenvatinib,which have a synergistic effect,are promising drugs for tumor treatment.It is generally believed that combination therapy with a PD-1 inhibitor and lenvatinib is safe and effective.However,we report a case of toxic epidermal necrolysis(TEN),a grade 4 toxicity,after this combination therapy.CASE SUMMARY A 39-year-old male presented with erythema,blisters and erosions on the face,neck,trunk and limbs 1 wk after receiving combination therapy with lenvatinib and toripalimab,a PD-1 inhibitor.The skin injury covered more than 70%of the body surface area.He was previously diagnosed with liver cancer with cervical vertebra metastasis.Histologically,prominent necrotic keratinocytes,hyperkeratosis,liquefaction of basal cells and acantholytic bullae were observed in the epidermis.Blood vessels in the dermis were infiltrated by lymphocytes and eosinophils.Direct immunofluorescence staining was negative.Thus,the diagnosis was confirmed to be TEN(associated with combination therapy with toripalimab and lenvatinib).Full-dose and long-term corticosteroids,high-dose intravenous immunoglobulin and targeted antibiotic drugs were administered.The rashes gradually faded;however,as expected,the tumor progressed.Therefore, sorafenib and regorafenib were given in succession, and the patient was still alive at the10-mo follow-up.CONCLUSIONCautious attention should be given to rashes that develop after combination therapy with PD-1inhibitors and lenvatinib. Large-dose and long-course glucocorticoids may be crucial for thetreatment of TEN associated with this combination treatment.

关 键 词：Toxic epidermal necrolysis Toripalimab Lenvatinib Programmed cell death-1 inhibitor Liver cancer Case report 

分 类 号：R735.7[医药卫生—肿瘤]