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ONCOLOGY

Evidence-Based Treatment Options for the Management of Skin Toxicities Associated with Epidermal Growth Factor Receptor Inhibitors

Pharmacy Student, Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore

Alexandre Chan, PharmD BCPS BCOP

Assistant Professor, Department of Pharmacy, Faculty of Science, National University of Singapore; Clinical Pharmacist, Department of Pharmacy, National Cancer Centre Singapore, Singapore

Reprints: Dr. Chan, Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4, 16 Science Dr. 4, Singapore 117543, fax (65) 6779 1554; phaac{at}nus.edu.sg

OBJECTIVE: To compile evidence from randomized controlled trials, case series, and case reports to identify the effectiveness of various therapeutic agents for the treatment and prevention of dermatologic effects secondary to epidermal growth factor receptor inhibitor (EGFRI) administration.

DATA SOURCES: Literature was accessed through PubMed (2002–May 2009) and Scopus (2002–March 2009), using the terms epidermal growth factor receptor inhibitor, cetuximab, erlotinib, gefitinib, panitumumab, management, skin toxicity, and cutaneous effects. In addition, reference citations from publications identified were reviewed.

STUDY SELECTION AND DATA EXTRACTION: An evaluation of published clinical trials, case series, case reports, and clinical management guidelines that studied the treatment options for EGFRI-induced skin toxicities was performed. Studies that reported dosing regimens and treatment outcomes were included in this review.

DATA SYNTHESIS: Management of EGFRI-induced skin toxicities has been documented in 2 randomized controlled trials, 3 case series, and 10 case reports in a total of 156 patients. There is strong evidence for the use of topical antibiotics to manage EGFRI skin toxicities. Controversy exists regarding the use of corticosteroids and retinoids for the management of EGFRI-induced rash. Several variables are noted among the number of case series and case reports, such as follow-up duration of the intervention, making any comparisons difficult.

CONCLUSIONS: Overall, antibiotics are the most common treatment option and have the potential to reduce the severity of skin rash. Well-designed clinical studies with proper recording of relevant data on the management of EGFRI-induced dermatologic effects are needed to properly evaluate the use of various therapeutic agents. Apart from randomized controlled trials, comprehensive case reports are also important for clinical evaluation on a case-by-case basis.

Key Words: cetuximab, cutaneous effects, epidermal growth factor receptor inhibitor, erlotinib, gefitinib, panitumumab, skin toxicity

Published Online, September 15, 2009. www.theannals.com, DOI 10.1345/aph.1M241