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Open Access 01-12-2014 | Clinical trial

Skin/nail infections with the addition of pertuzumab to trastuzumab-based chemotherapy

Authors: Joanne Mortimer, Jae Jung, Yuan Yuan, Laura Kruper, Daphne Stewart, Samuel Chung, Kim Wai Yu, Mary Mendelsohn, Massimo D’Apuzzo, Bernard Tegtmeier, Sanjeet Dadwal

Published in: Breast Cancer Research and Treatment | Issue 3/2014

Abstract

We report a series of breast cancer patients with invasive skin and nail infections with Staphylococcus species that we attribute to the addition of pertuzumab to trastuzumab-based therapy. With the suspicion of an increased incidence of cutaneous infection in patients treated with pertuzumab and trastuzumab-based chemotherapy, treating medical oncologists identified patients receiving therapy who experienced infection. Between March and October 2014, 18 patients treated with pertuzumab and trastuzumab-based chemotherapy were found to have 21 separate skin/nail infections. Treatment was administered as neoadjuvant therapy in 12 (67 %) patients, adjuvant therapy in four (22 %) patients, and for metastatic disease in two (11 %) patients. Granulocyte growth factors were administered in 11 (61 %) patients and no patients were documented to be neutropenic. New skin and nail lesions developed as early as cycle 1 and as late as 8 months from initial therapy. The 21 separate infections documented were folliculitis and “bite-like” lesions (10), abscess (6), paronychia (3), and cellulitis (2). The appearance of these lesions was distinct from typical EGFR-associated skin changes. When cultures were obtained, Staphylococcus species were isolated. Quantitative immunoglobulins were assessed in 14 (78 %) patients and were abnormally low in six (43 %) of these patients. The skin infections resulted in treatment delay in two (11 %) patients and premature discontinuation of therapy in one patient. We believe that the skin/nail infections reported here in patients treated with the combination of pertuzumab and trastuzumab represent a previously unrecognized toxicity of adding pertuzumab to trastuzumab-based therapies.

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Title: Skin/nail infections with the addition of pertuzumab to trastuzumab-based chemotherapy
Authors: Joanne Mortimer
Jae Jung
Yuan Yuan
Laura Kruper
Daphne Stewart
Samuel Chung
Kim Wai Yu
Mary Mendelsohn
Massimo D’Apuzzo
Bernard Tegtmeier
Sanjeet Dadwal
Publication date: 01-12-2014
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 3/2014
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-014-3190-5

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