{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:00:40Z","timestamp":1753891240568,"version":"3.41.2"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T00:00:00Z","timestamp":1622764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>EGFR tyrosine kinase inhibitors (TKIs) are the front-line treatment in <jats:italic>EGFR<\/jats:italic> mutation positive advanced non-small cell lung cancer (aNSCLC) patients. Generally, they are well-tolerated but skin toxicity is common (45\u2013100% of patients) and may adversely affect quality of life. Pathogenesis of cutaneous side effects is usually linked to EGFR expression in normal cells of the epidermis and not immune-related. Subacute cutaneous lupus erythematosus (SCLE) is an autoimmune disease and about 40% of SCLE cases are drug related, but no reports are available involving osimertinib. Our report depicts a drug induced-SCLE (DI-SCLE) caused by erlotinib and worsened by osimertinib. The adverse event is characterized by the absence of systemic symptoms. Diagnosis has been performed by skin biopsy and the conditions improved with systemic steroids administration and EGFR-TKIs discontinuation. The report underlines the importance of a complete dermatologic diagnosis of skin lesions induced by EGFR inhibitors, according to symptom severity and timing of improving with standard clinical management. The diagnosis of immune-related skin toxicity in this context affects the treatment and the outcome of skin toxicity and must be taken into account when planning subsequent treatments, potentially including immune checkpoint inhibitors (ICIs).<\/jats:p>","DOI":"10.3389\/fmed.2021.570921","type":"journal-article","created":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T06:09:31Z","timestamp":1622786971000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Subacute Cutaneous Lupus Erythematosus-Like Eruption Induced by EGFR -Tyrosine Kinase Inhibitor in EGFR-Mutated Non-small Cell Lung Cancer: A Case Report"],"prefix":"10.3389","volume":"8","author":[{"given":"Alessandra","family":"Ferro","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Filoni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Pavan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Pasello","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Guarneri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PierFranco","family":"Conte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Alaibac","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Bonanno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1056\/NEJMoa0810699","article-title":"Gefitinib or carboplatin\u2013paclitaxel in pulmonary adenocarcinoma","volume":"361","author":"Mok","year":"2009","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/S1470-2045(09)70364-X","article-title":"Gefitinib versus cisplatin plus docetaxel in patients with non-small-cell lung cancer harbouring mutations of the epidermal growth factor receptor (WJTOG3405): an open label, randomised phase 3 trial","volume":"11","author":"Mitsudomi","year":"2010","journal-title":"Lancet Oncol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2380","DOI":"10.1056\/NEJMoa0909530","article-title":"Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR","volume":"362","author":"Maemondo","year":"2010","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/S1470-2045(11)70184-X","article-title":"Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, phase 3 study","volume":"12","author":"Zhou","year":"2011","journal-title":"Lancet Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1016\/S1470-2045(11)70393-X","article-title":"Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial","volume":"13","author":"Rosell","year":"2012","journal-title":"Lancet Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1883","DOI":"10.1093\/annonc\/mdv270","article-title":"First-line erlotinib versus gemcitabine\/cisplatin in patients with advanced EGFR mutation-positive non-small-cell lung cancer: analyses from the phase III, randomized, open-label, ENSURE study","volume":"26","author":"Wu","year":"2015","journal-title":"Ann Oncol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"3327","DOI":"10.1200\/JCO.2012.44.2806","article-title":"Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations","volume":"31","author":"Sequist","year":"2013","journal-title":"J Clin Oncol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/S1470-2045(13)70604-1","article-title":"Afatinib versus cisplatin plus gemcitabine for first-line treatment of Asian patients with advanced non-small-cell lung cancer harbouring EGFR mutations (LUX-Lung 6): an open-label, randomised phase 3 trial","volume":"15","author":"Wu","year":"2014","journal-title":"Lancet Oncol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1056\/NEJMoa1612674","article-title":"Osimertinib or platinum\u2013pemetrexed in EGFR T790M\u2013positive lung cancer","volume":"376","author":"Mok","year":"2017","journal-title":"N Engl J Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1056\/NEJMoa1713137","article-title":"Osimertinib in untreated EGFR-mutated advanced non\u2013small-cell lung cancer","volume":"378","author":"Soria","year":"2018","journal-title":"N Engl J Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1056\/NEJMoa1913662","article-title":"Overall survival with osimertinib in untreated, EGFR-mutated advanced NSCLC","volume":"382","author":"Ramalingam","year":"2020","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"i3","DOI":"10.1093\/annonc\/mdx702","article-title":"Overview of current systemic management of EGFR-mutant NSCLC","volume":"29","author":"Hsu","year":"2018","journal-title":"Ann Oncol Off J Eur Soc Med Oncol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1159\/000371821","article-title":"Acneiform rash induced by EGFR inhibitors: review of the literature and new insights","volume":"1","author":"Fabbrocini","year":"2015","journal-title":"Ski Appendage Disord"},{"key":"B14","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1038\/nrc1970","article-title":"Mechanisms of cutaneous toxicities to EGFR inhibitors","volume":"2006","author":"Lacouture","year":"2006","journal-title":"Nat Rev Cancer"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.1001\/archderm.115.12.1409","article-title":"Subacute cutaneous lupus erythematosus: a cutaneous marker for a distinct lupus erythematosus subset","volume":"115","author":"Sontheimer","year":"1979","journal-title":"Arch Dermatol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/j.berh.2013.07.008","article-title":"Cutaneous lupus erythematosus: diagnosis and treatment","volume":"27","author":"Okon","year":"2013","journal-title":"Best Practice Res Clin Rheumatol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1001\/archdermatol.2008.619","article-title":"Subacute cutaneous lupus erythematosus associated with capecitabine monotherapy","volume":"145","author":"Rosenbach","year":"2009","journal-title":"Archiv Dermatol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1684\/ejd.2016.2912","article-title":"Drug-induced cutaneous lupus erythematosus: 88 new cases","volume":"27","author":"Laurinaviciene","year":"2017","journal-title":"Eur J Dermatology"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e328","DOI":"10.1111\/j.1365-2230.2009.03280.x","article-title":"Subacute cutaneous lupus erythematosus induced by capecitabine","volume":"34","author":"Floristan","year":"2009","journal-title":"Clin Exp Dermatol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1093\/jjco\/hys042","article-title":"Clinical impact of switching to a second EGFR-TKI after a severe AE related to a first EGFR-TKI in EGFR-mutated NSCLC","volume":"42","author":"Takeda","year":"2012","journal-title":"Jpn J Clin Oncol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1016\/j.jtho.2017.04.011","article-title":"The IASLC lung cancer staging project: external validation of the revision of the TNM stage groupings in the eighth edition of the TNM classification of lung cancer","volume":"12","author":"Chansky","year":"2017","journal-title":"J Thorac Oncol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.ejca.2008.10.026","article-title":"New response evaluation criteria in solid tumours: revised RECIST guideline (version 1","volume":"45","author":"Eisenhauer","year":"2009","journal-title":"Eur J Cancer"},{"key":"B23","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/j.clindermatol.2011.08.032","article-title":"Chemotherapy-induced iatrogenic injury of skin: new drugs and new concepts","volume":"29","author":"Choi","year":"2011","journal-title":"Clin Dermatol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1001\/jamadermatol.2013.4957","article-title":"Subacute cutaneous lupus erythematosus induced by chemotherapy: gemcitabine as a causative agent","volume":"149","author":"Wiznia","year":"2013","journal-title":"JAMA Dermatol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1111\/bjd.13175","article-title":"Subacute cutaneous lupus erythematosus induced by the new multikinase inhibitor pazopanib","volume":"171","author":"Casado-Verrier","year":"2014","journal-title":"Br J Dermatol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1177\/1203475417752369","article-title":"Subacute cutaneous lupus erythematosus induced by palbociclib","volume":"22","author":"Pinard","year":"2018","journal-title":"J Cutan Med Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1111\/ajco.12687","article-title":"Management of epidermal growth factor receptor tyrosine kinase inhibitor-related cutaneous and gastrointestinal toxicities","volume":"14","author":"Aw","year":"2018","journal-title":"Asia-Pacific J Clin Oncol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1097\/BOR.0000000000000522","article-title":"Drug-induced lupus erythematosus: an update on drugs and mechanisms","volume":"30","author":"He","year":"2018","journal-title":"Curr Opin Rheumatol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/j.jtho.2016.10.007","article-title":"Checkpoint inhibitors in metastatic EGFR-mutated non\u2013small cell lung cancer\u2014a meta-analysis","volume":"12","author":"Lee","year":"2017","journal-title":"J Thorac Oncol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1016\/S1470-2045(18)30144-X","article-title":"Durvalumab as third-line or later treatment for advanced non-small-cell lung cancer (ATLANTIC): an open-label, single-arm, phase 2 study","volume":"19","author":"Garassino","year":"2018","journal-title":"Lancet Oncol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"2288","DOI":"10.1056\/NEJMoa1716948","article-title":"Atezolizumab for first-line treatment of metastatic non-squamous NSCLC","volume":"378","author":"Socinski","year":"2018","journal-title":"N Engl J Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1056\/NEJMra1703481","article-title":"Immune-related adverse events associated with immune checkpoint blockade","volume":"378","author":"Postow","year":"2018","journal-title":"N Engl J Med"},{"key":"B33","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1097\/CMR.0000000000000587","article-title":"Cutaneous lupus associated with pembrolizumab therapy for advanced melanoma: a report of three cases","volume":"29","author":"Blakeway","year":"2019","journal-title":"Melanoma Res"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e67","DOI":"10.1136\/annrheumdis-2018-213677","article-title":"Drug-induced lupus erythematosus following immunotherapy with anti-programmed death-(ligand) 1","volume":"78","author":"Michot","year":"2019","journal-title":"Ann Rheumatic Dis"},{"key":"B35","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1097\/CMR.0000000000000536","article-title":"Subacute cutaneous lupus erythematosus induced by nivolumab: two case reports and a literature review","volume":"29","author":"Zitouni","year":"2019","journal-title":"Melanoma Res"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.570921\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T06:09:33Z","timestamp":1622786973000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.570921\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,4]]},"references-count":35,"alternative-id":["10.3389\/fmed.2021.570921"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.570921","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2021,6,4]]},"article-number":"570921"}}