Supportive Care in Cancer

, Volume 18, Issue 4, pp 509–522

A proposed EGFR inhibitor dermatologic adverse event-specific grading scale from the MASCC skin toxicity study group

  • Mario E. Lacouture
  • Michael L. Maitland
  • Siegfried Segaert
  • Ann Setser
  • Robert Baran
  • Lindy P. Fox
  • Joel B. Epstein
  • Andrei Barasch
  • Lawrence Einhorn
  • Lynne Wagner
  • Dennis P. West
  • Bernardo L. Rapoport
  • Mark G. Kris
  • Ethan Basch
  • Beth Eaby
  • Sandra Kurtin
  • Elise A. Olsen
  • Alice Chen
  • Janet E. Dancey
  • Andy Trotti
Original Article

Abstract

Background

Accurate grading of dermatologic adverse events (AE) due to epidermal growth factor receptor (EGFR) inhibitors (EGFRIs) is necessary for drug toxicity determinations, interagent comparisons, and supportive care trials. The most widely used severity grading scale, the National Cancer Institute’s Common Terminology Criteria for Adverse Events version 4.0 (NCI-CTCAE v4.0), was not designed specifically for this class of agents and may result in underreporting and poor grading of distinctive adverse events. We believe a class-specific grading scale is needed to help standardize assessment and improve reporting of EGFRI-associated dermatologic AEs.

Methods

The Multinational Association of Supportive Care in Cancer (MASCC) Skin Toxicity Study Group conducted an international multidisciplinary meeting that included 20 clinicians and researchers from academic centers and government agencies. Experts from different disciplines presented current information specific to EGFRI-induced dermatologic toxicities: grading scale development, pharmacovigilance safety reporting, health-related quality of life, patient reporting, and pharmacology. Group discussions, literature reviews, and professional expertise established the theoretical foundation for the proposed grading scale.

Results

A new grading system is proposed for the most common events associated with EGFRI-induced dermatologic AEs: papulopustular reaction or acneiform rash, nail changes, erythema, pruritus, xerosis, hair changes, telangiectasias, hyperpigmentation, mucositis, flushing, radiation dermatitis, hyposalivation, and taste changes. The proposed scale maintains consistency with the grading principles and language of the existing CTCAE version 4.0 and MedDRA terminology and includes relevant patient-reported health-related quality of life factors.

Conclusions

A grading scale specific to EGFR inhibitor dermatologic AEs is presented for formal integration into future versions of CTCAE and for validation in clinical trial settings. The study group designed this scale to detect and report EGFRI-related toxicities with greater sensitivity, specificity, and range than the scales currently used. This scale should serve as a foundation for efforts to perform objective interdrug comparisons and assessments of supportive care treatment strategies more effectively than with current methods.

Keywords

Adverse events Dermatologic Skin Mucosa Quality of life EGFR inhibitors Grading 

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Mario E. Lacouture
    • 1
  • Michael L. Maitland
    • 2
  • Siegfried Segaert
    • 3
  • Ann Setser
    • 4
  • Robert Baran
    • 5
  • Lindy P. Fox
    • 6
  • Joel B. Epstein
    • 7
  • Andrei Barasch
    • 8
  • Lawrence Einhorn
    • 9
  • Lynne Wagner
    • 1
    • 18
  • Dennis P. West
    • 1
    • 18
  • Bernardo L. Rapoport
    • 10
  • Mark G. Kris
    • 11
  • Ethan Basch
    • 11
  • Beth Eaby
    • 12
  • Sandra Kurtin
    • 13
  • Elise A. Olsen
    • 14
  • Alice Chen
    • 15
  • Janet E. Dancey
    • 16
  • Andy Trotti
    • 17
  1. 1.Dermatology ServiceRockefeller Outpatient PavilionNew YorkUSA
  2. 2.University of ChicagoChicagoUSA
  3. 3.University HospitalLeuvenBelgium
  4. 4.National Cancer InstituteRockvilleUSA
  5. 5.Nail Disease CentreCannesFrance
  6. 6.University of CaliforniaSan FranciscoUSA
  7. 7.University of IllinoisChicagoUSA
  8. 8.University of Alabama at BirminghamBirminghamUSA
  9. 9.Indiana UniversityIndianapolisUSA
  10. 10.The Medical Oncology Centre of RosebankJohannesburgSouth Africa
  11. 11.Memorial Sloan-Kettering Cancer CenterNew YorkUSA
  12. 12.University of PennsylvaniaPhiladelphiaUSA
  13. 13.University of ArizonaTucsonUSA
  14. 14.Duke UniversityDurhamUSA
  15. 15.National Cancer InstituteRockvilleUSA
  16. 16.Ontario Institute for Cancer ResearchTorontoCanada
  17. 17.H. Lee Moffitt Cancer CenterTampaUSA
  18. 18.Northwestern UniversityChicagoUSA

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