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Skin Appendage Disorders Mar 2015Acneiform rash is the most common side effect of epidermal growth factor receptor (EGFR) inhibitors (EGFRis), and it occurs in 50-100% of patients. This condition can... (Review)
Review
Acneiform rash is the most common side effect of epidermal growth factor receptor (EGFR) inhibitors (EGFRis), and it occurs in 50-100% of patients. This condition can affect the quality of life of these patients and can sometimes lead to a discontinuation of the antineoplastic therapy. Several recent prospective studies have addressed and evaluated different interventions to mitigate or reduce the severity of EGFRis-associated skin rash. With this aim, we have established a dermocosmetological outpatient clinic for cancer patients at the Department of Clinical Medicine and Surgery, University of Naples Federico II in collaboration with the Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami. An interdisciplinary network of physicians can improve the quality of life of the cancer patients, focusing on such important aspects as dermocosmetological skin care, but also on the evaluation of new therapeutic and diagnostic algorithms in order to make further progress in the field of prevention. In this review, we summarize the state of the art of the epidemiology, pathogenesis, and treatment of EGFRis acneiform rash, and we describe our outpatient clinical experience.
PubMed: 27171241
DOI: 10.1159/000371821 -
Journal of the European Academy of... Dec 2014Epidermal growth factor receptor inhibitors (EGFRi) and MEK inhibitors (MEKi) are notorious for causing papulopustular rash. Treatment recommendations from studies and...
BACKGROUND
Epidermal growth factor receptor inhibitors (EGFRi) and MEK inhibitors (MEKi) are notorious for causing papulopustular rash. Treatment recommendations from studies and expert panels include, amongst others, oral tetracyclines. The efficacy of retarded low-dose doxycycline (rld-doxycycline), however, has not been investigated. The objective was to review the response and development of EGFRi- and MEKi-induced rash under therapy with rld-doxycycline.
PATIENTS AND METHOD
A retrospective review of all patients treated with rld-doxycyline 40 mg once daily between September 2011 and June 2012 for papulopustular rash. Rash development and severity (according to the Common Terminology Criteria of Adverse Events V4.0) were assessed.
RESULTS
Seventeen patients (13 men, 4 women) were treated with rld-doxycycline while receiving EGFRi [monoclonal antibodies (mab) n = 8, tyrosine kinase inhibitors (TKi) n = 7] or MEKi (n = 2). In 47% (n = 8) the rash was reduced by at least one grade, in 29% (n = 5) the rash was stabilized, 24% (n = 4) did not profit from the treatment. All patients treated with an EGFR-TKi or a MEKi profited of the rld-doxycycline. All patients who experienced deterioration were on treatment with an EGFR-mab.
CONCLUSIONS
Rld-doxycyline can improve EGFR-TKi- and MEKi-induced rash severity. Its effectiveness appears to be inferior to doxycycline 200 mg/day in more severe cases and in EGFR-mab-induced rash, but due to the advantageous side-effect profile, rld-doxycycline should be considered as a possible treatment option for papulopustular rash. Prospective, randomized trials are necessary to confirm these findings.
Topics: Aged; Anti-Bacterial Agents; Dose-Response Relationship, Drug; Doxycycline; ErbB Receptors; Exanthema; Female; Humans; MAP Kinase Kinase Kinases; Male; Middle Aged; Protein Kinase Inhibitors
PubMed: 24422792
DOI: 10.1111/jdv.12365 -
Journal of Dermatological Case Reports Jun 2015Erlotinib is a targeted anti-cancer drug which acts through the inhibition of epidermal growth factor receptor (EGFR).
BACKGROUND
Erlotinib is a targeted anti-cancer drug which acts through the inhibition of epidermal growth factor receptor (EGFR).
MAIN OBSERVATIONS
A 79-year-old developed bilateral ectropion after he received erlotinib treatment for lung adenocarcinoma. The ectropion completely resolved with symptomatic treatment without any modification in erlotinib therapy.
CONCLUSIONS
EGFR inhibitors are frequently associated with a variety of mucocutaneous adverse events. Ocular toxicity associated with these agents has been reported rarely. We present this case to underline the importance of recognition of newly reported cutaneous and ocular adverse events of targeted therapies.
PubMed: 26236413
DOI: 10.3315/jdcr.2015.1203 -
BMJ Case Reports Jul 2022Bevacizumab-induced rash is a rarely reported complication with very few insights into its epidemiology, pathophysiology, management and relationship with therapeutic...
Bevacizumab-induced rash is a rarely reported complication with very few insights into its epidemiology, pathophysiology, management and relationship with therapeutic efficacy. We report a case of ruptured occipital arteriovenous malformation treated with stereotactic radiosurgery. The patient developed steroid-resistant radiosurgery-induced brain oedema. Oedema partially responded to bevacizumab, and the patient tolerated the treatment well except for skin rash. He developed multiple discrete monomorphic papulopustular lesions with intervening hyperpigmented macules after bevacizumab intravenous infusion. The patient was further treated with benzoyl peroxide gel for local application and oral doxycycline. The rash reappeared whenever bevacizumab was reintroduced to the regimen beyond 7.5 mg/kg body weight at 3 weekly intervals. After dose modification to 5 mg/kg body weight, 6 cycles were administered with no further rash and resolution of oedema. There is no need to halt bevacizumab therapy, although it can be continued at a lesser dose as it may be a dose-dependent complication.
Topics: Antineoplastic Agents, Immunological; Bevacizumab; Body Weight; Brain Edema; Exanthema; Humans; Male; Radiosurgery
PubMed: 35868802
DOI: 10.1136/bcr-2022-249844 -
Clinical Lung Cancer Dec 2006Many novel targeted agents have emerged against a variety of malignancies. Although papulopustular rash is the most commonly observed side effect associated with many of... (Review)
Review
Many novel targeted agents have emerged against a variety of malignancies. Although papulopustular rash is the most commonly observed side effect associated with many of these agents, several non-rash skin toxicities have been identified that frequently result in the delay or discontinuation of anticancer therapy. These toxicities include skin hyperpigmentation, xerosis, pruritus, hair growth and color abnormalities, periungual and nail alterations, and hand-foot skin reaction. It is important to recognize these toxicities, so that they can be diagnosed early and treatment or dose modification can be initiated, if necessary. This review discusses several non-rash dermatologic toxicities observed with targeted therapeutic agents and guidelines for their diagnosis and treatment.
Topics: Angiogenesis Inhibitors; Antineoplastic Agents; Humans; Neoplasms; Protein Kinase Inhibitors; Skin Diseases; Telangiectasis
PubMed: 17239289
DOI: 10.3816/clc.2006.s.012 -
Actas Dermo-sifiliograficas 2015
Topics: Dermatologists; EGF Family of Proteins; Exanthema; Humans; Protein Kinase Inhibitors
PubMed: 26028577
DOI: 10.1016/j.ad.2015.05.001 -
Journal of the European Academy of... Jun 2017
Topics: Administration, Topical; Antiparasitic Agents; ErbB Receptors; Exanthema; Humans; Ivermectin; Male; Middle Aged; Mite Infestations; Remission Induction; Rosacea
PubMed: 27988991
DOI: 10.1111/jdv.14089 -
European Journal of Oncology Nursing :... Feb 2016The primary end-point was to describe the clinical course of monoclonal antibody-induced papulopustular rash (mAB-induced PPR), when patients alert health-care providers...
PURPOSE
The primary end-point was to describe the clinical course of monoclonal antibody-induced papulopustular rash (mAB-induced PPR), when patients alert health-care providers and the subsequent reactive measures employed. Exploring the predictors affecting PPR grading was the secondary end-point.
METHODS
A multicentre retrospective study involving six Italian oncology outpatient departments was conducted. Thirty-nine patients with cancer undergoing cetuximab or panitumumab treatment were included. Information was collected through medical records and face-to-face interviews. mAB-induced PPR was scored by patients' self-reported Common Terminology Criteria for Adverse Eventsv4.02 and was defined as severe when the grade ≥3.
RESULTS
Thirty-five (89.7%) patients developed a rash, which was severe in nine cases. The rash usually appeared within the first week after starting the drug (22, 62.8%), peaked in severity during the first month (26, 74.3%) and resolved 4-8 weeks after the end of mABs therapy (15, 45.7%). At the time of the interviews, the rash was not still resolved in almost half (n = 16) of the patients. Twenty-six (74.3%) patients reported sequelae and the mostly common were erythema (21, 81%) and dry skin (14, 54%). Only half of the patients informed health-care professionals as soon as the rash appeared. All the patients treated the rash topically and mAB therapy was modified in 16 (45.7%) cases (reduction, n = 10; discontinuation, n = 9; withdrawal, n = 2). No association between male gender, age, fair skin, current smokers during therapy and PPR grading escalation was found.
CONCLUSIONS
The clinical course of the rash was pathognomonic. Patients should be further encouraged to communicate the onset of a rash to health-care professionals as soon as it appears to avoid grading escalation and sequelae. The adoption of CTCAE as a patient-reported outcome may become an instrument to help health-care providers in tailoring treatment measures.
Topics: Aged; Antibodies, Monoclonal; Antineoplastic Agents; Cetuximab; Colorectal Neoplasms; Drug Eruptions; Exanthema; Female; Humans; Italy; Male; Middle Aged; Retrospective Studies
PubMed: 26187661
DOI: 10.1016/j.ejon.2015.07.003 -
BMJ Case Reports 2009Human epidermal growth factor receptor (EGFR) is an attractive target for anticancer therapy. EGFR tyrosine kinase inhibitors are generally well tolerated and do not...
Human epidermal growth factor receptor (EGFR) is an attractive target for anticancer therapy. EGFR tyrosine kinase inhibitors are generally well tolerated and do not have the severe systemic side-effects usually seen with cytotoxic drugs. A specific adverse effect common to this class of agent is a papulopustular rash, usually on the face and upper torso. During prolonged treatment with EGFR inhibitors, changes of the hairs can be noticed. This report describes a rare case of a non-small-cell lung cancer with hair changes after several months of treatment with the EGFR inhibitor gefitinib. The patient's scalp hair grew more slowly and adopted a finer, more brittle and curly aspect. However, the eyelashes, eyebrows and hair of other parts of the face did not display similar changes. Little is known about the aetiology of this kind of hair alteration, and there are no clear evidence-based management recommendations. Histological data indicate that the hair alteration may be caused by EGFR inhibition in skin, although this has not been confirmed. Further studies are needed to investigate the reason for this phenomenon.
PubMed: 21686587
DOI: 10.1136/bcr.09.2008.0878 -
American Journal of Therapeutics 2020
Topics: Angiogenesis Inhibitors; Antineoplastic Combined Chemotherapy Protocols; ErbB Receptors; Exanthema; Humans; Lenalidomide; Male; Middle Aged; Multiple Myeloma
PubMed: 32618603
DOI: 10.1097/MJT.0000000000001169