By: Rakesh Mehra, Abel Zachariah, Aisha Nadeem
Docetaxel is a widely used chemotherapy agent used in breast cancer. Although uncommon, docetaxel-induced severe cutaneous adverse reactions including erythema multiforme major, Stevens-Johnson syndrome and toxic epidermal necrolysis have been reported. We present a case of a patient with breast cancer developing an erythematous rash covering 20% of her total body surface area where malnutrition and severe hypoalbuminemia of 17g/L were present. This occurred 17 days post cycle five administration of her chemotherapy - docetaxel and Phesgo (pertuzumab, trastuzumab and hyaluronidase). Punch biopsy confirmed erythema multiforme-type cutaneous reaction. Despite appropriate medical management, the patient passed away 10 days after hospital admission due to cancer progression. The pharmacokinetics of docetaxel are discussed, and we conclude that due to its extensive protein binding, hypoalbuminemia and malnutrition may contribute to the risk of docetaxel-induced toxicities. This case highlights the potential need to monitor albumin and nutritional status in patients receiving docetaxel to mitigate toxicities.
