Cancer Treatment Side Effects: A Dermatologist's Perspective

Mr. S: The Golfer's Unexpected Challenge

Mr. S was an avid golfer and a loving husband, father, and grandfather. His life took a dramatic turn when, at the age of 72, he was diagnosed with stage IV lung cancer (adenocarcinoma). Having just retired, he had dreams of traveling and creating lasting memories with his family. His doctor recommended a treatment plan that included a combination of chemotherapy (carboplatin and pemetrexed) along with immunotherapy (pembrolizumab). Not knowing what to expect, he was pleasantly surprised to tolerate the first two cycles well, experiencing only some fatigue.

However, after the third cycle, he developed fluid-filled blisters on his face, lips, and upper body. Although they were not painful, they were inflamed and itchy. Despite his oncologist's efforts, the rash remained untreated. Living several hours away from a cancer center and lacking access to knowledgeable dermatologists in his town, Mr. S faced uncertainty about continuing his treatment.

Ms. A: A Miracle Treatment's Unforeseen Consequence

Ms. A, a 76-year-old single mother, had worked hard all her life, juggling two jobs while raising her children. A non-smoker, she was devastated by her lung cancer diagnosis. She began treatment with pembrolizumab and initially experienced an incredible response, believing she had found a miracle treatment. Unfortunately, her joy was short-lived as she developed a rash resembling warts all over her body after her 8th cycle of treatment. The rash was unbearably itchy. Living in a group facility, she was initially misdiagnosed with scabies and treated with permethrin multiple times. After three additional treatments, her doctor stopped pembrolizumab as the rash worsened despite oral steroid treatment. She became miserable, unable to sleep due to the itching, and was isolated in her facility because others believed she had scabies.

The Importance of Specialized Care

It took several weeks for patients like Mr. S and Ms. A to find relief for their rashes. They needed a dermatologist familiar with their conditions who could think outside the box to find effective treatments. Fortunately, both patients were treated as outpatients, avoiding hospital admissions and the associated risk of hospital-acquired infections, which is crucial given their lung cancer diagnoses.

These cases have been documented in leading medical journals, accessible via Pubmed:

1. "Successful Outpatient Management of Diffuse Photosensitive Bullous Dermatitis Following Pembrolizumab Therapy" [Link]

2. "Resolution of Pembrolizumab‐Associated Steroid‐Refractory Lichenoid Dermatitis with Cyclosporine" [Link]

Citrus Oncology's mission aligns with improving care for patients suffering from side effects that can be addressed only when you have a multi-specialty approach to cancer supportive care.

At Citrus Oncology, we are passionate about improving care and outcomes for patients with such stories. Our mission is to connect people suffering from cancer with the right care at the right time, enabling them to continue their cancer therapy for better outcomes. We aim to reduce fear through science and knowledge, ensuring patients receive the best possible care.

If you or someone you know is suffering from a condition that is preventing them from getting their cancer therapy, we are here to help. Don't let side effects hold you back from potentially life-saving treatment. Reach out to Citrus Oncology today.

By Dr. Meenal Kheterpal, MD

Physician and Advisor, Citrus Oncology