TITLE:
A Rare Case of Severe Muscular Necrosis Due to Extravascular Leakage of Trabectedin—Severe Tissue Damage of Trabectedin Extravasation
AUTHORS:
Reika Aoyama, Atsushi Tanemura, Madoka Takafuji, Yorihisa Kotobuki, Aya Tanaka, Ichiro Katayama, Satoshi Takenaka
KEYWORDS:
Trabectedin, Management of Extravasation, Vesicant Drug, Follicular Dendritic Cell Sarcoma, Muscular Involvement
JOURNAL NAME:
Journal of Cosmetics, Dermatological Sciences and Applications,
Vol.8 No.1,
March
8,
2018
ABSTRACT: Trabectedin is a synthetic antineoplastic drug,
binding to the minor groove of DNA and affecting DNA repair pathways, resulting
in G2-M cell cycle arrest and apoptosis. Trabectedin has demonstrated high
efficacy against various soft tissue sarcomas. However, its extravasation
causes serious complications, such as tissue necrosis and a delay in the
treatment of underlying diseases. Methods: We experienced a rare case in which
trabectedin extravasation caused severe pectoralis major muscle necrosis. A
45-year-old man with multiple lung metastases of follicular dendritic cell
sarcoma received 2.15 mg of trabectedin totally through a central venous access device (CVAD)
system in the right precordium. Computed tomography showed extensive turbidity
of subcutaneous fatty tissue and swelling of the pectoralis major muscle to the
upper margin of the liver, and the creatine kinase level was elevated to 759
U/L (reference value from 54 to 286). We performed surgical debridement twice,
and the CVAD was concomitantly removed; thereafter, the skin defect was
reconstructed with a split skin mesh graft. Results: Histopathology showed
extreme degeneration of striated muscle and fatty tissue. Unfortunately, disability of the right arm abducens
persisted after treatment because of debridement around the right humerus
muscle. Discussion: Several reports have described cases of the extravasation
of trabectedin. A few have mentioned
severe muscular degeneration similar to that shown in the present case. Because
trabectedin is a strong vesicant cytotoxic agent, it is principally
administered through a CVAD rather than peripheral vessels and is continued
during the nighttime; this can lead to a delay in patients or attending doctors
noticing any extravasation. We need to spread appropriate knowledge of this
drug and make an effort to prevent severe complications like in the present
case.