Resident's Forum
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
Autor para correspondencia
Departamento de Dermatología, Hospital 12 de Octubre, Madrid, Spain
Leído
3640
Vecesse ha leído el artículo
1540
Total PDF
2100
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219019301660" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.12.027" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "2007" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2019;110:499-500" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731018302928" "issn" => "00017310" "doi" => "10.1016/j.ad.2017.12.019" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "2007" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2019;110:499-500" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 298 "formatos" => array:2 [ "HTML" => 208 "PDF" => 90 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">FORO DEL RESIDENTE</span>" "titulo" => "FR - Inhibidores del factor de crecimiento epidérmico y toxicidad cutánea: en busca de un protocolo de manejo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "499" "paginaFinal" => "500" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "RF - Epidermal Growth Factor Receptor Inhibitors and Skin Toxicity: The Search for a Management Protocol" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.J. Andrés-Lencina, R. Aragón-Miguel, A. Calleja-Algarra" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J.J." "apellidos" => "Andrés-Lencina" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Aragón-Miguel" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Calleja-Algarra" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219019301660" "doi" => "10.1016/j.adengl.2017.12.027" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019301660?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018302928?idApp=UINPBA000044" "url" => "/00017310/0000011000000006/v1_201907020633/S0001731018302928/v1_201907020633/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219019300514" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.02.012" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "1964" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2019;110:e15" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 12 "HTML" => 12 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">e-Images in Dermatology</span>" "titulo" => "Recurrent Perimenstrual Vesicles Inside the Ear: A Rare Presentation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "e15" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vesículas perimenstruales recurrentes en el interior de la oreja. Una presentación inusual" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 621 "Ancho" => 650 "Tamanyo" => 69407 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Zawar, M. Pawar, S. Kumavat" "autores" => array:3 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Zawar" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Pawar" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Kumavat" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018302023" "doi" => "10.1016/j.ad.2017.11.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018302023?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019300514?idApp=UINPBA000044" "url" => "/15782190/0000011000000006/v1_201907040838/S1578219019300514/v1_201907040838/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219019300356" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.02.003" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "2069" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:497-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2 "formatos" => array:2 [ "HTML" => 1 "PDF" => 1 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Fast-Growing Occipital Tumor" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "497" "paginaFinal" => "498" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumoración occipital de rápido crecimiento" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 459 "Ancho" => 900 "Tamanyo" => 202518 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×2.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Varas-Meis, C. Prada-García, P. Fernández-Canga, M.Á. Rodriguez-Prieto" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Varas-Meis" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Prada-García" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Fernández-Canga" ] 3 => array:2 [ "nombre" => "M.Á." "apellidos" => "Rodriguez-Prieto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018304356" "doi" => "10.1016/j.ad.2017.11.025" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018304356?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019300356?idApp=UINPBA000044" "url" => "/15782190/0000011000000006/v1_201907040838/S1578219019300356/v1_201907040838/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident's Forum</span>" "titulo" => "RF - Epidermal Growth Factor Receptor Inhibitors and Skin Toxicity: The Search for a Management Protocol" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "499" "paginaFinal" => "500" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.J. 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." "fecha" => "2010" "volumen" => "28" "paginaInicial" => "1351" "paginaFinal" => "1357" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011000000006/v1_201907040838/S1578219019301660/v1_201907040838/en/main.assets" "Apartado" => array:4 [ "identificador" => "34945" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Resident's Forum" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011000000006/v1_201907040838/S1578219019301660/v1_201907040838/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019301660?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 18 | 11 | 29 |
| 2024 Octubre | 76 | 43 | 119 |
| 2024 Septiembre | 74 | 21 | 95 |
| 2024 Agosto | 99 | 75 | 174 |
| 2024 Julio | 101 | 25 | 126 |
| 2024 Junio | 51 | 27 | 78 |
| 2024 Mayo | 60 | 30 | 90 |
| 2024 Abril | 64 | 21 | 85 |
| 2024 Marzo | 58 | 26 | 84 |
| 2024 Febrero | 64 | 29 | 93 |
| 2024 Enero | 59 | 31 | 90 |
| 2023 Diciembre | 52 | 17 | 69 |
| 2023 Noviembre | 71 | 24 | 95 |
| 2023 Octubre | 63 | 24 | 87 |
| 2023 Septiembre | 43 | 31 | 74 |
| 2023 Agosto | 28 | 15 | 43 |
| 2023 Julio | 41 | 33 | 74 |
| 2023 Junio | 35 | 19 | 54 |
| 2023 Mayo | 37 | 22 | 59 |
| 2023 Abril | 23 | 19 | 42 |
| 2023 Marzo | 28 | 29 | 57 |
| 2023 Febrero | 30 | 31 | 61 |
| 2023 Enero | 30 | 21 | 51 |
| 2022 Diciembre | 42 | 32 | 74 |
| 2022 Noviembre | 41 | 40 | 81 |
| 2022 Octubre | 35 | 30 | 65 |
| 2022 Septiembre | 27 | 44 | 71 |
| 2022 Agosto | 26 | 60 | 86 |
| 2022 Julio | 29 | 43 | 72 |
| 2022 Junio | 32 | 33 | 65 |
| 2022 Mayo | 35 | 36 | 71 |
| 2022 Abril | 38 | 27 | 65 |
| 2022 Marzo | 41 | 39 | 80 |
| 2022 Febrero | 25 | 15 | 40 |
| 2022 Enero | 23 | 32 | 55 |
| 2021 Diciembre | 31 | 36 | 67 |
| 2021 Noviembre | 28 | 37 | 65 |
| 2021 Octubre | 28 | 49 | 77 |
| 2021 Septiembre | 31 | 32 | 63 |
| 2021 Agosto | 21 | 25 | 46 |
| 2021 Julio | 15 | 19 | 34 |
| 2021 Junio | 13 | 26 | 39 |
| 2021 Mayo | 23 | 31 | 54 |
| 2021 Abril | 31 | 54 | 85 |
| 2021 Marzo | 43 | 20 | 63 |
| 2021 Febrero | 41 | 21 | 62 |
| 2021 Enero | 37 | 13 | 50 |
| 2020 Diciembre | 14 | 14 | 28 |
| 2020 Noviembre | 14 | 14 | 28 |
| 2020 Octubre | 20 | 15 | 35 |
| 2020 Septiembre | 23 | 10 | 33 |
| 2020 Agosto | 28 | 12 | 40 |
| 2020 Julio | 10 | 12 | 22 |
| 2020 Junio | 15 | 18 | 33 |
| 2020 Mayo | 9 | 9 | 18 |
| 2020 Abril | 16 | 12 | 28 |
| 2020 Marzo | 8 | 4 | 12 |
| 2020 Febrero | 2 | 2 | 4 |
Mostrar todo
