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Prophylactic versus reactive treatment of acneiform skin rashes from epidermal growth factor receptor inhibitors in metastatic colorectal cancer

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Abstract

Purpose

There are concerns regarding potential negative effects of prophylactic treatment of epidermal growth factor receptor (EGFR)-inhibitor-related rashes on metastatic colorectal cancer (mCRC) outcomes. We aimed to characterize treatment patterns of EGFR-inhibitor-induced rashes and evaluate prophylactic versus reactive approaches to rash management in relation to overall survival (OS).

Methods

Patients diagnosed with KRAS wild-type mCRC from July 2010 to June 2012 in British Columbia and prescribed cetuximab or panitumumab were reviewed to describe patterns of use of oral antibiotics and steroid creams. Using Cox regression, the relationship between prophylactic versus reactive rash management and OS was characterized.

Results

A total 119 patients were analyzed: median age was 63 years, 61 % were male, 34 % received cetuximab, 66 % received panitumumab, and median number of EGFR inhibitor treatment was nine cycles. Rash occurred in >90 % of patients, and reactive was favored over prophylactic treatment (66 vs. 34 %). Older patients and those with Eastern Cooperative Oncology Group (ECOG) performance status 0/1 were more likely to receive prophylactic creams (44 vs. 20 % for age <60, p = 0.01) and oral antibiotics (62 vs. 12 % for ECOG ≥2, p = 0.01), respectively. Median OS was 7.0 months. The number of treatment cycles and OS were similar in both prophylactic and reactive groups (both p > 0.05). In Cox regression, ECOG >2 correlated with worse survival (hazard ratio (HR) 22.01, 95 % confidence interval (CI) 5.25–92.30, p < 0.01). However, survival outcomes were similar between patients prescribed antibiotics prophylactically versus reactively (HR = 1.10, 95 % CI 0.43–2.80, p = 0.85), and steroid creams prophylactically versus reactively (HR = 2.00, 95 % CI 0.58–6.92, p = 0.27).

Conclusion

Prophylactic treatment of EGFR-inhibitor-related rashes is associated with similar outcomes compared to reactive rash treatment in mCRC.

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Acknowledgments

Authors would like to gratefully acknowledge the British Columbia Cancer Foundation and the Canadian Cancer Society Research Institute for their support in making this research possible.

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This study was funded by British Columbia Cancer Foundation and the Canadian Cancer Society Research Institute.

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There are no prior submissions to other journals.

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Authors and Affiliations

  1. Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada

    Bogdan Dascalu, Hagen F. Kennecke, Howard J. Lim, Daniel J. Renouf & Winson Y. Cheung

  2. Division of Medical Oncology, British Columbia Cancer Agency, Vancouver Clinic, 4415, 600 West 10th Avenue, 4th Floor, Vancouver, BC, V5Z 4E6, Canada

    Hagen F. Kennecke, Howard J. Lim, Daniel J. Renouf, Jenny Y. Ruan, Jennifer T. Chang & Winson Y. Cheung

Authors
  1. Bogdan Dascalu
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  2. Hagen F. Kennecke
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  3. Howard J. Lim
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  4. Daniel J. Renouf
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  5. Jenny Y. Ruan
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  6. Jennifer T. Chang
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  7. Winson Y. Cheung
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Corresponding author

Correspondence to Winson Y. Cheung.

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Dascalu, B., Kennecke, H.F., Lim, H.J. et al. Prophylactic versus reactive treatment of acneiform skin rashes from epidermal growth factor receptor inhibitors in metastatic colorectal cancer. Support Care Cancer 24, 799–805 (2016). https://doi.org/10.1007/s00520-015-2846-y

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  • DOI: https://doi.org/10.1007/s00520-015-2846-y

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