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Cutaneous side effects in breast cancer patients treated with cytostatic polychemotherapy and rh GM-CSF: Immune phenomena or drug toxicity?

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Summary

The application of recombinant colony stimulating factors for chemotherapy induced granulocytopenia is becoming common in clinical oncology. Here we report on localized cutaneous side effects after subcutaneous administration of recombinant human granulocyte-macrophage colony-stimulating factor (rh GM-CSF) in 11 patients with breast cancer receiving cytostatic treatment. Seven patients suffering from inflammatory breast cancer received cytostatic chemotherapy with mitoxantrone/cyclophosphamide, whereas four patients suffering from noninflammatory breast cancer received high-dose epirubicin/cyclophosphamide, respectively. rh GM-CSF was applicated subcutaneously in a dose of 5 µg/kg/d for at least ten days. In all patients, sharply demarked, maculous itching and burning erythemas restricted to the injection sites occured after three to four injections of rh GM-CSF. These eruptions cleared within 2 to 3 weeks, but reappeared after reexposure to rh GM-CSF. In contrast to previous sporadic reports, no generalized erythemas were observed. Because of this unexpected and subjectively intolerable side effect, rh GM-CSF administration had to be interrupted in all patients. Histopathological findings revealed skin infiltration with lymphocytes, monocytes/macrophages, neutrophils, and occasionally eosinophils, respectively. Since GM-CSF is known to alter immune functions, it seems likely that the eruptions were at least in part due to local immune reactions.

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Authors and Affiliations

  1. Institute of Clinical Pathology, University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria

    Ingrid Simonitsch

  2. Department of Surgery, University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria

    Michael F. X. Gnant & Raimund Jakesz

  3. Department of Internal Medicine I, Division of Oncology, University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria

    Gottfried J. Locker, Ingrid Simonitsch, Robert M. Mader, Elisabeth Warlamides, Michael F. X. Gnant, Raimund Jakesz, Hugo Rainer & Günther G. Steger

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  1. Gottfried J. Locker
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  2. Ingrid Simonitsch
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  3. Robert M. Mader
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  4. Elisabeth Warlamides
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  6. Raimund Jakesz
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  7. Hugo Rainer
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  8. Günther G. Steger
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Locker, G.J., Simonitsch, I., Mader, R.M. et al. Cutaneous side effects in breast cancer patients treated with cytostatic polychemotherapy and rh GM-CSF: Immune phenomena or drug toxicity?. Breast Cancer Res Tr 34, 213–219 (1995). https://doi.org/10.1007/BF00689712

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