Abstract
Epidermal growth factor receptor (EGFR)-targeted therapies (monoclonal antibodies such as cetuximab and panitumumab as well as tyrosine kinase inhibitors like erlotinib and gefitinib) are responsible for a unique constellation of mechanism-based, class-specific side effects on the skin. Besides the well-known acneiform eruption, this skin toxicity consists of xerosis (leading to eczema and fissures), paronychia, hair changes, telangiectasia, hyperpigmentation, and mucosal changes. Dermatologic treatment is supportive and aims at maintaining quality of life while continuing EGFR-inhibitor therapy. Although a recent study demonstrated the effectiveness of prophylactic minocycline in cetuximab-induced acneiform eruption, randomized controlled trials remain sparse and evidence-based guidelines are lacking. Based on personal experience, most cases of acneiform eruption are well controlled by topical metronidazole and oral minocycline 100 mg qd. For severe reactions, minocycline dose is doubled and saline compresses have proven very valuable. For superinfection with Staphylococcus aureus, oral cefuroxim axetil can be added for a short term. Emollients and topical steroids can be administered for skin dryness or eczema. Paronychia is the hardest part to treat but antiseptic soaks and a corticosteroid paste can alleviate symptoms to some degree.
Similar content being viewed by others
References
Johnston JB, Navaratnam S, Pitz MW et al (2006) Targeting the EGFR pathway for cancer therapy. Curr Med Chem 13:3483–3492
Busam KJ, Capodieci P, Motzer R et al (2001) Cutaneous side-effects in cancer patients treated with the antiepidermal growth factor receptor antibody C225. Br J Dermatol 144:1169–1176
Segaert S, Van Cutsem E (2005) Clinical signs, pathophysiology and management of skin toxicity during therapy with epidermal growth factor receptor inhibitors. Ann Oncol 16:1425–1433
Lacouture ME (2006) Mechanisms of cutaneous toxicities to EGFR inhibitors. Nat Rev Cancer 6:803–812
Melichar B, Nemcova I (2007) Eye complications of cetuximab therapy. Eur J Cancer Care 16:439–443
Perez-Soler R, Saltz L (2005) Cutaneous adverse effects with HER1/EGFR-targeted agents: Is there a silver lining? J Clin Oncol 23:5235–5246
Van Cutsem E (2006) Challenges in the use of epidermal growth factor receptor inhibitors in colorectal cancer. Oncologist 11:1010–1017
Segaert S, Tabernero J, Chosidow O et al (2005) The management of skin reactions in cancer patients receiving epidermal growth factor receptor targeted therapies. J Dtsch Dermatol Ges 3:599–606
Hetherington J, Andrews C, Vaynshteyn Y et al (2007) Managing follicular rash related to chemotherapy and monoclonal antibodies. Community Oncol 4:157–162
Segaert S, Van Cutsem E (2007) Clinical management of EGFRI dermatologic toxicities: the Europe perspective. Oncology 5(Suppl 11):22–26
Jatoi A, Rowland K, Sloan JA et al (2008) Tetracycline to prevent epidermal growth factor receptor inhibitor-induced skin rashes. Results of a placebo-controlled trial from the North Central Cancer Treatment Group (N03CB). Cancer 113:847–853
Scope A, Agero ALC, Dusza SW et al (2007) Randomized double-blind trial of prophylactic oral minocycline and topical tazarotene for cetuximab-associated acne-like eruption. J Clin Oncol 25:5390–5396
Robert C, Soria J-C, Spatz A et al (2005) Cutaneous side-effects of kinase inhibitors and blocking antibodies. Lancet Oncol 6:491–500
Lacouture ME, Basti S, Patel J et al (2006) The SERIES clinic: an interdisciplinary approach to the management of toxicities of EGFR inhibitors. J Support Oncol 4:236–238
Guillot B, Bessis D (2006) Aspects cliniques et prise en charge des effets secondaires cutanés des inhibiteurs du récepteur à l’EGF. Ann Dermatol Venereol 133:1017–1020
Gutzmer R, Werfel T, Kapp A et al (2006) Kutane Nebenwirkungen einer EGF-Receptor-Blockade und deren management. Hautarzt 57:509–513
Galimont-Collen AFS, Vos LE, Lavrijsen APM et al (2007) Classification and management of skin, hair, nail and mucosal side-effects of epidermal growth factor receptor (EGFR) inhibitors. Eur J Cancer 43:845–851
Monti M, Motta S (2007) Clinical management of cutaneous toxicity of anti-EGFR-agents. Int J Biol Markers 22:S53–S61
Perez-Soler R, Delord JP, Halpern A et al (2005) HER1/EGFR inhibitor-associated rash: future directions for management and investigation outcomes from the HER1/EGFR inhibitor rash management forum. Oncologist 10:345–356
Lynch TJ, Kim ES, Eaby B et al (2007) Epidermal growth factor receptor inhibitor-associated cutaneous toxicities: an evolving paradigm in clinical management. Oncologist 12:610–621
Luu M, Lai SE, Patel J et al (2007) Photosensitive rash due to the epidermal growth factor receptor inhibitor erlotinib. Photodermatol Photoimmunol Photomed 23:42–45
Bernier J, Bonner J, Vermorken J et al (2008) Consensus guidelines for the management of radiation dermatitis and co-existing acne-like rash in patients receiving radiotherapy plus EGFR inhibitors for the treatment of squamous cell carcinoma of the head and neck. Ann Oncol 19:142–149
Plewig G, Kligman AM (2000) (eds) Acne and rosacea, 3d ed. Springer-Verlag, Berlin.
Perez-Soler R (2006) Topical vitamin K3 (menadione) prevents erlotinib and cetuximab-induced EGFR inhibition in the skin (abstract). J Clin Oncol 2006 ASCO Annual Meeting Proceedings Part 1 24:3036
Suh K-Y, Kindler HL, Medenica M et al (2006) Doxycycline for the treatment of paronychia induced by the epidermal growth factor receptor inhibitor cetuximab. Br J Dermatol 154:191–192
Conflict of interest statement
No funds were received in support of this study. The author has been a paid speaker for Merck-Serono, Amgen and Roche.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Segaert, S. Management of skin toxicity of epidermal growth factor receptor inhibitors. Targ Oncol 3, 245–251 (2008). https://doi.org/10.1007/s11523-008-0092-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11523-008-0092-7