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Clinical and Experimental Dermatology Oct 2011Epidermal growth factor receptor inhibitors (EGFRIs) are associated with a characteristic papulopustular rash, an adverse event considered to be a class effect of these...
BACKGROUND
Epidermal growth factor receptor inhibitors (EGFRIs) are associated with a characteristic papulopustular rash, an adverse event considered to be a class effect of these agents. Erlotinib, a small-molecule EGFRI, causes a papulopustular rash in 68-75% of patients. The limited reported data suggest that deleterious effects of ultraviolet radiation (UVR) may enhance the development of EGFRI-induced rash. Because the level of the biological pigment melanin correlates with increased protection against UVR, we hypothesized that lighter levels of skin pigmentation are associated with greater severity of rash.
AIM
To characterize the relationship between skin phototype (SPT) and rash severity.
METHODS
A retrospective chart review was conducted of 40 patients on erlotinib. Skin sensitivity to UVR was categorized using the Fitzpatrick SPT classification scheme. Grading of rash was performed using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 3.
RESULTS
There was an inverse relationship between SPT and rash severity. Grade 0 was seen in the majority of patients with SPT V/VI, grade 1/2 in the majority of patients with SPT III/IV, and grade 3/4 rash in the majority of patients with SPT I/II (grade 0: 7% SPT I/II, 32% SPT III/IV and 50% SPT IV/V; grade 1/2: 33%, 63% and 50%, respectively; grade 3/4: 60%, 5% and 0%, respectively) (P < 0.01, Fisher exact test).
CONCLUSIONS
Prevention and management of cutaneous side-effects from EGFR inhibitors is important to achieve maximum patient compliance and therapeutic benefit. The results of this study suggest that SPT may be an independent predictive factor for EGFRI-induced papulopustular rash, thus pre-therapy counselling and early intervention are important.
Topics: Adult; Aged; Aged, 80 and over; Drug Eruptions; Erlotinib Hydrochloride; Exanthema; Female; Humans; Incidence; Male; Middle Aged; Protein Kinase Inhibitors; Quinazolines; Retrospective Studies; Severity of Illness Index; Skin Pigmentation; United States
PubMed: 21689147
DOI: 10.1111/j.1365-2230.2011.04117.x -
Immunology and Allergy Clinics of North... Aug 2014Use of cytotoxic agents is associated with potential hypersensitivity reactions which are common with platinum compounds, L-asparaginase, taxanes, procarbazine and... (Review)
Review
Use of cytotoxic agents is associated with potential hypersensitivity reactions which are common with platinum compounds, L-asparaginase, taxanes, procarbazine and epipodophyllotoxins. Mechanisms underlying the reactions may involve IgE, non-allergic or a number of pathogenetically unclear events. Targeted therapies produce less collateral damage but demonstrate their own unique reactions. Cytopenias occur less often and mucocutaneous reactions to EGFR inhibitors, including papulopustular rash, are common. Fifteen currently approved mAbs provoke all four types of hypersensitivities including immune cytopenias, vasculitis, serum sickness and pulmonary events. Some successful desensitization protocols have been developed. Prevention of hypersensitivity reactions is based on skin testing, premedication and/or desensitization.
Topics: Antineoplastic Agents; Desensitization, Immunologic; Drug Hypersensitivity; Humans; Premedication; Risk Factors
PubMed: 25017678
DOI: 10.1016/j.iac.2014.04.003 -
Acta Dermatovenerologica Croatica : ADC Apr 2016Skin and skin adnexa toxicities are the most common side effects associated with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and occur in...
Skin and skin adnexa toxicities are the most common side effects associated with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and occur in most patients receiving this therapy. The majority of these cutaneous side effects are transient, reversible, and dose dependent. Although these symptoms are in general not severe, they significantly affect quality of life and can have a serious effect on treatment compliance as well as the treatment regimen. The most common early symptoms present as papulopustules on an erythematous base, usually localized in seborrheic areas. This clinical presentation is commonly described as "acneiform", although these adverse reactions have clinical presentations, such as rosacea-like and seborrheic-like dermatitis. In this context, we report a case of a 77-year-old man with a medical history of planocellular lung cancer with ipsilateral pulmonary metastasis and mediastinum infiltration who received erlotinib as a third-line therapy, presenting with centrofacial rosaceiform rash as a side effect associated with the use of EGFR-TKIs. The patient had a negative previous history of rosacea. Therefore, symptoms probably occurred as an adverse reaction due to the oncological therapy. Current terminology of early cutaneous adverse reactions caused by EGFR-TKIs refers to "acneiform" or "papulopustular" lesions, excluding less common side effects such as rosacea-like dermatitis so these symptoms might be overlooked and misdiagnosed. Thus, we would like to emphasize the importance of developing a more accurate classification of terms in order to provide early detection of all possible cutaneous side effects, including less common ones, providing specific and timely treatment, and allowing continuation of drug therapy.
Topics: Aged; Antineoplastic Agents; Drug Eruptions; Erlotinib Hydrochloride; Humans; Male; Rosacea
PubMed: 27149133
DOI: No ID Found -
Wiener Medizinische Wochenschrift (1946) Dec 2015Subantimicrobial doxycycline is an anti-inflammatory drug that decreases cathelicidin, kallikrein 5, reactive oxygen species, nitric oxide, and matrix...
Subantimicrobial doxycycline is an anti-inflammatory drug that decreases cathelicidin, kallikrein 5, reactive oxygen species, nitric oxide, and matrix metalloproteinases. Clinical trials demonstrated a comparable efficacy to 100-mg doxycycline in papulopustular rosacea with improvement of inflammatory lesions, quality of life, and improved safety profile. Case series and case reports suggested efficacy in other inflammatory skin diseases. The response of papulopustular rash during targeted anticancer therapies is mixed. Further studies are needed.
Topics: Anti-Inflammatory Agents; Clinical Trials as Topic; Dermatitis, Perioral; Dose-Response Relationship, Drug; Doxycycline; Facial Dermatoses; Humans; Rosacea; Scalp Dermatoses; Treatment Outcome
PubMed: 26564206
DOI: 10.1007/s10354-015-0399-9 -
Expert Review of Anticancer Therapy Jun 2013Dermatologic adverse events (AEs) are frequently observed in patients receiving EGF receptor (EGFR; also known as ErbB1) tyrosine kinase inhibitor therapy. The impact of... (Review)
Review
Dermatologic adverse events (AEs) are frequently observed in patients receiving EGF receptor (EGFR; also known as ErbB1) tyrosine kinase inhibitor therapy. The impact of these AEs goes beyond cosmesis to the discomfort from itching, pain and secondary infections, all of which may significantly impact on patient well-being, adherence and clinical outcomes. Afatinib is a potent, irreversible, oral, ErbB family blocker, inhibiting EGFR (ErbB1), HER2 (ErbB2) and ErbB4 receptor kinases. It also inhibits transphosphorylation of ErbB3. Similar to EGFR inhibitors, dermatologic AEs have been frequently observed in patients treated with afatinib. Papulopustular (acneiform) rash, pruritus, xerosis, paronychia and alopecia will require patient education and proactive treatment interventions. This article summarizes current data on the dermatologic AEs associated with afatinib treatment across the clinical trial program, and provides strategies for their effective management.
Topics: Administration, Oral; Afatinib; Alopecia; Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; ErbB Receptors; Exanthema; Humans; Paronychia; Protein Kinase Inhibitors; Pruritus; Quinazolines; Receptor, ErbB-2
PubMed: 23506519
DOI: 10.1586/era.13.30 -
Critical Reviews in Oncology/hematology Jun 2017The epidermal growth factor receptor (EGFR) is involved in development and progression of some gastrointestinal cancers, and is targeted by monoclonal antibodies (mAbs)... (Review)
Review
The epidermal growth factor receptor (EGFR) is involved in development and progression of some gastrointestinal cancers, and is targeted by monoclonal antibodies (mAbs) and tyrosine kinase inhibitors (TKIs) used to treat these conditions. Targeted agents are generally better tolerated than conventional chemotherapy, but have characteristic toxicities that can affect adherence, dosing, and outcomes. Skin conditions are the most common toxicities associated with EGFR inhibitors, particularly papulopustular rash. Other common toxicities include mucosal toxicity, electrolyte imbalances (notably hypomagnesaemia), and diarrhoea, while the chimaeric mAb cetuximab is also associated with increased risk of infusion reactions. With appropriate prophylaxis, the incidence and severity of these events can be reduced, while management strategies tailored to the patient and the degree of toxicity can help to ensure continuation of anti-cancer therapy. Here, we review the main toxicities associated with EGFR-inhibiting mAbs and TKIs in patients with gastrointestinal cancers, and provide recommendations for prophylaxis and treatment.
Topics: Antineoplastic Agents; Disease Management; Drug-Related Side Effects and Adverse Reactions; ErbB Receptors; Gastrointestinal Neoplasms; Humans
PubMed: 28477738
DOI: 10.1016/j.critrevonc.2017.03.032 -
Journal of Clinical Oncology : Official... Aug 2005The human epidermal growth factor receptor (HER1/EGFR) is dysregulated in many solid tumors, making it an attractive target for anticancer therapy. A number of agents... (Review)
Review
The human epidermal growth factor receptor (HER1/EGFR) is dysregulated in many solid tumors, making it an attractive target for anticancer therapy. A number of agents that target this receptor are in use or in development. A specific adverse effect common to this class of agent is a papulopustular rash, usually on the face and upper torso, which generally occurs in a dose-dependent manner. Little is known about the etiology of this rash, and there are no clear evidence-based management recommendations. Histologic data indicate that rash may be caused by HER1/EGFR inhibition in skin, although this has not been confirmed. Findings suggest that there is a relationship between the development of rash and response and/or survival, making rash a potential surrogate marker of activity. Data from multiple studies with cetuximab and erlotinib show a consistent relationship between rash and response, as well as between rash and survival. The relationship between rash and clinical outcome is currently less consistent for gefitinib. Some studies report a correlation, whereas others do not. The cause of the possible relationship between rash and clinical benefit remains unclear at this time, and additional studies are needed to determine the clinical utility of this observation.
Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Biomarkers, Tumor; Cetuximab; ErbB Receptors; Erlotinib Hydrochloride; Exanthema; Humans; Neoplasms; Prognosis; Protein Kinase Inhibitors; Quinazolines; Survival Analysis; Treatment Outcome
PubMed: 16051966
DOI: 10.1200/JCO.2005.00.6916 -
Asia-Pacific Journal of Oncology Nursing 2017The epidermal growth factor receptor (EGFR) is actively involved in the growth of multiple tumor types and has been found as an effective treatment target in various... (Review)
Review
The epidermal growth factor receptor (EGFR) is actively involved in the growth of multiple tumor types and has been found as an effective treatment target in various solid cancers, for example, lung cancer and head and neck cancer. Of effective drugs which target and inhibit EGFR functions, tyrosine kinase inhibitors have shown promising results, albeit at a cost of side effects, skin toxicity being the most common. This article provides an evidence-based strategy to oncology nurse practitioners in dealing with such toxicity.
PubMed: 28966961
DOI: 10.4103/apjon.apjon_28_17 -
Journal of the American Academy of... Oct 2014Dermatologic toxicities from targeted agents such as panitumumab can interfere with cancer treatment.
BACKGROUND
Dermatologic toxicities from targeted agents such as panitumumab can interfere with cancer treatment.
OBJECTIVE
We sought to evaluate the rash assessment and management in a consecutive patient cohort who received panitumumab for colorectal cancer treatment.
METHODS
This was a retrospective chart review.
RESULTS
Skin toxicity, consisting of papulopustular rash, was experienced by 32 of 34 patients. The majority (85%) developed the rash by the end of the second infusion cycle. Patients presented with a mild (41%), moderate (38%), and severe (21%) rash, and progressed to an extensive rash without appropriate treatment. A grading system was used for 65% of patients to document severity.
LIMITATIONS
Small sample size limited power in analysis. Rash severity had to be inferred based on rash description and management in 11 of the patients.
CONCLUSION
Dermatologic toxicities related to panitumumab are common; however, the way they are reported and managed varies among physicians. To prevent progression, toxicities must be assessed and treated early and aggressively, according to severity grading. Dermatologists could aid oncologists in choosing the best management strategies.
Topics: Acneiform Eruptions; Adult; Aged; Antibodies, Monoclonal; Antineoplastic Agents; Chemotherapy, Adjuvant; Cohort Studies; Colorectal Neoplasms; Dermatologic Agents; Drug Eruptions; Exanthema; Female; Follow-Up Studies; Humans; Male; Middle Aged; Ontario; Panitumumab; Retrospective Studies; Risk Assessment; Severity of Illness Index; Treatment Outcome
PubMed: 25085331
DOI: 10.1016/j.jaad.2014.06.011 -
The Nursing Clinics of North America Mar 2017Cancer treatments usually have side effects of bone marrow depression, mucositis, hair loss, and gastrointestinal issues. Rarely do we think of skin side effects until... (Review)
Review
Cancer treatments usually have side effects of bone marrow depression, mucositis, hair loss, and gastrointestinal issues. Rarely do we think of skin side effects until patients have been treated successfully with epidermal growth factor receptor inhibitors (EGFRi). Those reactions include papulopustular rash, hair changes, radiation dermatitis enhancement, pruritus, mucositis, xerosis, fissures, and paronychia. This article discusses the common skin reactions seen when using EGFRi and presents an overview of skin as the largest and important organ of the body, including an overview of skin assessment, pathophysiology of the skin reactions, nursing care involved, and introduction to oncodermatology.
Topics: Antineoplastic Agents; Drug-Related Side Effects and Adverse Reactions; ErbB Receptors; Humans; Neoplasms; Skin Diseases
PubMed: 28189168
DOI: 10.1016/j.cnur.2016.11.005