Dacomitinib-Induced Paronychia Associated With PRIDE Syndrome in a Patient With Non-Small Cell Lung Cancer

Area of Science:

• Oncology
• Dermatology
• Pharmacology

Background:

• Epidermal growth factor receptor (EGFR) inhibitors are crucial for treating non-small cell lung cancer (NSCLC) with EGFR mutations.
• These therapies often induce cutaneous toxicities, including papulopustules, paronychia, hair growth abnormalities, itching, and dryness, collectively termed PRIDE syndrome.

Observation:

• A 55-year-old male with advanced NSCLC developed toe-predominant paronychia, a papulopustular rash on the trunk and limbs, and diarrhea 4-8 weeks after starting dacomitinib.
• Causality assessment using Naranjo, WHO-UMC, and Liverpool tools indicated a probable relationship between dacomitinib and the observed adverse events.

Findings:

• Adverse effects were managed symptomatically, enabling uninterrupted dacomitinib therapy and dose maintenance.
• This case documents an atypical presentation of PRIDE syndrome with early onset and a unique toe-predominant distribution.

Implications:

• Early recognition and symptomatic management of EGFR inhibitor-induced toxicities are vital for patient adherence and treatment success.
• This case underscores the importance of pharmacovigilance and reporting to optimize the safe use of EGFR inhibitors in NSCLC treatment.
• Successful management of these adverse events without dose modification or discontinuation can improve patient outcomes in EGFR-mutated NSCLC.