PROGRESSIVE SYSTEMIC SCLEROSIS IN PATIENT WITH METASTATIC PAROTIS CARCINOMA UNDER CHEMOTHERAPY WITH PACLITAXEL: A CASE FOR THE AUTOIMMUNE BOARD
- Marija Geroldinger-Simic, Austria
Abstract
Background and Aims
We report on a 66 years old female patient with systemic sclerosis (first diagnosed in year 2016 with limited skin sclerosis, anti-Scl-70-antibody, raynaud symptoms) who developed metastatic parotiscarcinoma (lung, lymph nodes) in march 2019 and was introduced to chemotherapy with paclitaxel.
Methods
After four cycles of therapy with paclitaxel, CT-scan showed regression of lung metastases. At the same time, massive progression of systemic sclerosis with diffuse skin sclerosis and new manifestations like digital ulcers, dysphagia with oesophageal hypomotility, lung fibrosis and pulmonal arterial hypertension occurred. Moreover, the patient developed leuco- and thrombocytopenia due to chemotherapy.
Results
Since several cases of induction of scleroderma-like skin lesions during the therapy with paclitaxel were described in the literature, chemotherapy with paclitaxel was paused after consultation of an oncologist. We started prednisolone (10 mg daily) and mycophenolate-mofetil (1 g daily) in order to improve lung fibrosis and skin sclerosis which were the most prominent manifestations of systemic sclerosis in our patient. Unfortunately, the patient could not take mycophenolate-mofetil because of dysphagia and burning in the mouth. Currently we are planning to start extracorporeal photopheresis as well as therapy with nintedanib.
Conclusions
Management of patients with autoimmune and metastatic tumour diseases demands interdisciplinary exchange, for which we suggest autoimmune board meetings (including dermatologists, cardiologists, oncologists, pulmonologists, pathologists, rheumatologists and radiologists).