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RF - Epidermal Growth Factor Receptor Inhibitors and Skin Toxicity: The Search for a Management Protocol
FR - Inhibidores del factor de crecimiento epidérmico y toxicidad cutánea: en busca de un protocolo de manejo
J.J. Andrés-Lencina
, R. Aragón-Miguel, A. Calleja-Algarra
Corresponding author
Departamento de Dermatología, Hospital 12 de Octubre, Madrid, Spain
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Andrés-Lencina, R. Aragón-Miguel, A. Calleja-Algarra" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J.J." "apellidos" => "Andrés-Lencina" "email" => array:1 [ 0 => "jjandreslen@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Aragón-Miguel" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Calleja-Algarra" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Hospital 12 de Octubre, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR - Inhibidores del factor de crecimiento epidérmico y toxicidad cutánea: en busca de un protocolo de manejo" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Epidermal growth factor receptor (EGFR) inhibitors have revolutionized the treatment of cancer. Skin involvement is one of their most prevalent adverse effects. These agents often have a considerable impact on the patient's quality of life and constitute a common reason for consulting a dermatologist.</p><p id="par0010" class="elsevierStylePara elsevierViewall">EGFR plays an important role in epidermal and pilosebaceous homeostasis and restricts interleukin 1–dependent inflammation at the level of the hair follicle.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Its inhibition frequently causes a folliculocentric papulopustular reaction, mainly affecting sebaceous areas (face, neck, retroauricular area, shoulders, intermammary space, and scalp), with no palmoplantar involvement. The term “acneiform”, which is widely used to describe these reactions, is erroneous because of the absence of comedones, nodules, and cysts, as well as the pruriginous character of the reactions.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Papulopustular reaction occurs early, typically during the first 2<span class="elsevierStyleHsp" style=""></span>weeks after starting the drug. The reaction is dose-dependent and is more severe with monoclonal antibodies than with tyrosine-kinase inhibitors. Severity is associated with antitumor effectiveness and with survival rates.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Reactions are classified into different grades depending on their intensity, impact on patient quality of life, extension, and whether or not they affect activities of daily living. Despite the absence of clinical trials in this area, various case series and experience based on clinical practice have made it possible to draw up a series of guidelines for treatment.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows recommendations for management of papulopustular rash, according to the latest clinical practice guidelines and criteria used to define the intensity of the reaction.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">However, we do have more solid evidence on preventive treatment. The Skin Toxicity Evaluation Protocol with Panitumumab (STEPP) study revealed a statistically significant decrease in the incidence of grade ≥2 reactions in more than 50% of patients and in the time to onset of reactions, with no added adverse effects in the arm that received preventive treatment with a combination of low-potency topical corticosteroids, skin moisturizers, sunscreen, and doxycycline 100<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h with respect to reactive treatment (any treatment considered by the investigator, from 1 to 6<span class="elsevierStyleHsp" style=""></span>weeks).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> A subsequent study that compared the preventive efficacy of minocycline with placebo revealed statistically significant findings after 8 weeks of treatment. Various studies have been performed to evaluate the preventive efficacy of tetracycline, tazarotene, pimecrolimus, and sunscreen in monotherapy, although none revealed statistically significant results.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Given the increasing use of these agents and their predominantly cutaneous toxicity and considerable impact on quality of life, which may even lead to suspension of a treatment that is essential for the patient, dermatologists should know how to recognize and manage these reactions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1131871" "palabras" => array:4 [ 0 => "EGFR inhibitors" 1 => "Cutaneous toxicity" 2 => "Papulopustular reaction" 3 => "Treatment guide" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Andrés-Lencina JJ, Aragón-Miguel R, Calleja-Algarra A. FR - Inhibidores del factor de crecimiento epidérmico y toxicidad cutánea: en busca de un protocolo de manejo. Actas Dermosifiliogr. 2019;110:499–500.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviation: BSA, body surface area.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 1, mild(< 10% BSA affected, practically asymptomatic. No impact on activities of daily living or instrumental activities of daily living. No superinfection) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low/medium-potency corticosteroids 1-2 times dailyTopical clindamycin 2%, 1- 2 times daily \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 2, moderate(10%-30% BSA affected, mild symptoms. Impact on instrumental activities of daily living. No superinfection) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Minocycline or doxycycline 100 mg/12 h \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 3, severe(> 30% BSA affected, intense symptoms. Significant impact on activities of daily living. Superinfection or risk of superinfection) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isotretinoin 20 mg/24 hEvaluate suspending the drug (at least 2 wk)Evaluate adding oral corticosteroids, prednisone 0.5 mg/kg for 7 d \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2076610.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Recommendations for the Management of Papulopustular Rash Caused by Epidermal Growth Factor Receptor Inhibitors.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin toxicity caused by EGFR antagonists-an autoinflammatory condition triggered by deregulated IL-1 signaling?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "U. Rodeck" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jcp.21585" "Revista" => array:6 [ "tituloSerie" => "J Cell Physiol." "fecha" => "2009" "volumen" => "218" "paginaInicial" => "32" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18781585" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The SERIES clinic: An interdisciplinary approach to the management of toxicities of EGFR inhibitors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.E. Lacouture" 1 => "S. Basti" 2 => "J. Patel" 3 => "A. Benson 3rd" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Support Oncol" "fecha" => "2006" "volumen" => "4" "paginaInicial" => "236" "paginaFinal" => "238" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intrapatient cetuximab dose escalation in metastatic colorectal cancer according to the grade of early skin reactions: the randomized EVEREST study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Van Cutsem" 1 => "S. Tejpar" 2 => "D. Vanbeckevoort" 3 => "M. Peeters" 4 => "Y. Humblet" 5 => "H. Gelderblom" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Oncol." "fecha" => "2012" "volumen" => "30" "paginaInicial" => "2861" "paginaFinal" => "2868" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.E. Lacouture" 1 => "M.J. Anadkat" 2 => "R.J. Bensadoun" 3 => "J. Bryce" 4 => "A. Chan" 5 => "J.B. Epstein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Support Care Cancer." "fecha" => "2011" "volumen" => "19" "paginaInicial" => "1079" "paginaFinal" => "1095" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous toxicities of molecular targeted therapies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.L. Stanculeanu" 1 => "D. Zob" 2 => "O.C. Toma" 3 => "B. Georgescu" 4 => "L. Papagheorghe" 5 => "R.I. Mihaila" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Maedica (Buchar)." "fecha" => "2017" "volumen" => "12" "paginaInicial" => "48" "paginaFinal" => "54" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin toxicity evaluation protocol with panitumumab (STEPP), a phase <span class="elsevierStyleSmallCaps">ii</span>, 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" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.E. Lacouture" 1 => "E.P. Mitchell" 2 => "B. Piperdi" 3 => "M.V. Pillai" 4 => "H. Shearer" 5 => "N. Iannotti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Oncol." 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| 2023 November | 71 | 24 | 95 |
| 2023 October | 63 | 24 | 87 |
| 2023 September | 43 | 31 | 74 |
| 2023 August | 28 | 15 | 43 |
| 2023 July | 41 | 33 | 74 |
| 2023 June | 35 | 19 | 54 |
| 2023 May | 37 | 22 | 59 |
| 2023 April | 23 | 19 | 42 |
| 2023 March | 28 | 29 | 57 |
| 2023 February | 30 | 31 | 61 |
| 2023 January | 30 | 21 | 51 |
| 2022 December | 42 | 32 | 74 |
| 2022 November | 41 | 40 | 81 |
| 2022 October | 35 | 30 | 65 |
| 2022 September | 27 | 44 | 71 |
| 2022 August | 26 | 60 | 86 |
| 2022 July | 29 | 43 | 72 |
| 2022 June | 32 | 33 | 65 |
| 2022 May | 35 | 36 | 71 |
| 2022 April | 38 | 27 | 65 |
| 2022 March | 41 | 39 | 80 |
| 2022 February | 25 | 15 | 40 |
| 2022 January | 23 | 32 | 55 |
| 2021 December | 31 | 36 | 67 |
| 2021 November | 28 | 37 | 65 |
| 2021 October | 28 | 49 | 77 |
| 2021 September | 31 | 32 | 63 |
| 2021 August | 21 | 25 | 46 |
| 2021 July | 15 | 19 | 34 |
| 2021 June | 13 | 26 | 39 |
| 2021 May | 23 | 31 | 54 |
| 2021 April | 31 | 54 | 85 |
| 2021 March | 43 | 20 | 63 |
| 2021 February | 41 | 21 | 62 |
| 2021 January | 37 | 13 | 50 |
| 2020 December | 14 | 14 | 28 |
| 2020 November | 14 | 14 | 28 |
| 2020 October | 20 | 15 | 35 |
| 2020 September | 23 | 10 | 33 |
| 2020 August | 28 | 12 | 40 |
| 2020 July | 10 | 12 | 22 |
| 2020 June | 15 | 18 | 33 |
| 2020 May | 9 | 9 | 18 |
| 2020 April | 16 | 12 | 28 |
| 2020 March | 8 | 4 | 12 |
| 2020 February | 2 | 2 | 4 |
Show all
