Vol 6, No 6 (2010)
Review paper
Published online: 2011-02-24
The management of skin reactions during epidermal growth factor receptor inhibitors in patients with colorectal cancer
Onkol. Prak. Klin 2010;6(6):318-332.
Abstract
The epidermal growth factor receptor (EGFR) is a transmembrane glycoprotein expressed by a number
of cell types of epithelial origin.
The use of EGFR inhibitors is associated with various adverse effects, including the most common ones: skin reactions (the so-called skin toxicity) developing in over half of the treated patients. Their intensification is often the reason for drug dose reduction or even treatment discontinuance. In view of the existing relationship between the response to treatment with EGFR inhibitors, expressed as progression-free survival or overall survival, and the skin reactions, it is currently recommended to opt for managing and alleviating the skin reactions rather than for reducing the drug dose or discontinuing the therapy with EGFR inhibitors.
There is available only a limited amount of data from clinical trials on this issue, hence the need to collate and systematise the information concerning the practical approach to adverse effects involving skin.
The data contained in this publication may prove useful in everyday clinical practice and facilitate the decision-making as regards the prevention, treatment and alleviation of skin lesions, as well as the therapeutic approach with the use of EGFR inhibitors itself. An effective treatment of skin symptoms ensures appropriate drug dosage and adequate quality of life of the patient.
The use of EGFR inhibitors is associated with various adverse effects, including the most common ones: skin reactions (the so-called skin toxicity) developing in over half of the treated patients. Their intensification is often the reason for drug dose reduction or even treatment discontinuance. In view of the existing relationship between the response to treatment with EGFR inhibitors, expressed as progression-free survival or overall survival, and the skin reactions, it is currently recommended to opt for managing and alleviating the skin reactions rather than for reducing the drug dose or discontinuing the therapy with EGFR inhibitors.
There is available only a limited amount of data from clinical trials on this issue, hence the need to collate and systematise the information concerning the practical approach to adverse effects involving skin.
The data contained in this publication may prove useful in everyday clinical practice and facilitate the decision-making as regards the prevention, treatment and alleviation of skin lesions, as well as the therapeutic approach with the use of EGFR inhibitors itself. An effective treatment of skin symptoms ensures appropriate drug dosage and adequate quality of life of the patient.
Keywords:
metastatic colorectal cancerskin toxicityEGFR inhibitorspanitumumab
Onkol. Prak. Klin. 2010; 6, 6: 318–332
References
- Carpenter G, Cohen S. Epidermal growth factor. J Biol Chem. 1990; 265: 7709–7712.
- Rowinsky E. The erbB Family: Targets for Therapeutic Development Against Cancer and Therapeutic Strategies Using Monoclonal Antibodies and Tyrosine Kinase Inhibitors. Annual Review of Medicine. 2004; 55(1): 433–457.
- Salomon DS, Brandt R, Ciardiello F, et al. Epidermal growth factor-related peptides and their receptors in human malignancies. Crit Rev Oncol Hematol. 1995; 19(3): 183–232.
- Agero AL, Dusza SW, Benvenuto-Andrade C, et al. Dermatologic side effects associated with the epidermal growth factor receptor inhibitors. J Am Acad Dermatol. 2006; 55(4): 657–670.
- Van Cutsem E, Peeters M, Siena S, et al. Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol. 2007; 25(13): 1658–1664.
- Hecht JR, Patnaik A, Berlin J, et al. Panitumumab monotherapy in patients with previously treated metastatic colorectal cancer. Cancer. 2007; 110(5): 980–988.
- Van Cutsem E, Siena S, Humblet Y, et al. An open-label, single-arm study assessing safety and efficacy of panitumumab in patients with metastatic colorectal cancer refractory to standard chemotherapy. Ann Oncol. 2008; 19(1): 92–98.
- Cunningham D, Humblet Y, Siena S, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med. 2004; 351(4): 337–345.
- Saltz LB, Meropol NJ, Loehrer PJ, et al. Phase II trial of cetuximab in patients with refractory colorectal cancer that expresses the epidermal growth factor receptor. J Clin Oncol. 2004; 22(7): 1201–1208.
- Lacouture ME. Mechanisms of cutaneous toxicities to EGFR inhibitors. Nat Rev Cancer. 2006; 6(10): 803–812.
- NCI-CTCAE. https://cabig-kc.nci.nih. gov/Vocab/KC/index.php/CTCAE.
- Pérez-Soler R, Delord JP, Halpern A, et al. HER1/EGFR inhibitor-associated rash: future directions for management and investigation outcomes from the HER1/EGFR inhibitor rash management forum. Oncologist. 2005; 10(5): 345–356.
- Lacouture ME, Maitland ML, Segaert S, et al. A proposed EGFR inhibitor dermatologic adverse event-specific grading scale from the MASCC skin toxicity study group. Support Care Cancer. 2010; 18(4): 509–522.
- Lacouture ME, Mitchell EP, Piperdi B, et al. Skin toxicity evaluation protocol with panitumumab (STEPP), a phase II, open-label, randomized trial evaluating the impact of a pre-Emptive Skin treatment regimen on skin toxicities and quality of life in patients with metastatic colorectal cancer. J Clin Oncol. 2010; 28(8): 1351–1357.