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Current Recommendations and Novel Strategies for the Management of Skin Toxicities Related to Anti-EGFR Therapies in Patients with Metastatic Colorectal Cancer

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Abstract

The use of targeted therapies, when added to conventional chemotherapy, has significantly improved clinical outcomes and survival of cancer patients. While targeted therapies do not have the systemic adverse reactions of chemotherapy, they are associated with toxicities that can be severe and impair patient quality of life and adherence to anti-cancer treatment. Panitumumab and cetuximab, two monoclonal antibodies against epidermal growth factor receptor (EGFR), are recommended for the treatment of metastatic colorectal cancer (mCRC). The majority of patients with mCRC who are treated with anti-EGFR therapy develop skin toxicities, including papulopustular rash (the most common), xerosis, painful cracks and fissures on the palms and soles of the feet, paronychia, pruritus, and abnormal hair and eyelash growth; they are also more prone to skin infections. Given the involvement of EGFR in normal epidermis physiology, development and function, skin toxicities caused by anti-EGFR therapy are not unexpected. In recent years, recommendations have been formulated for the prevention and treatment of anti-EGFR therapy-related skin toxicities. Indeed, proper and timely management of these toxicities is important for ensuring uninterrupted anti-cancer treatment and optimal outcomes. Here, we review the current knowledge of anti-EGFR therapy-related skin toxicities and the latest recommendations for their management. We also present a treatment approach for papulopustular rash based on the combination of fusidic acid plus betamethasone in a lipid-enriched topical formulation. The effectiveness of this approach is documented by the presentation of five cases successfully treated in clinical practice for anti-EGFR therapy-related rash.

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Acknowledgements

The authors would like to thank Lorenza Lanini, who drafted the outline and first draft of this manuscript on behalf of Springer Healthcare Communications, and Sarah Greig, Ph.D., of Springer Healthcare Communications, who carried out an English edit of the manuscript. This editorial assistance was supported by LEO Pharma.

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Authors and Affiliations

  1. Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy

    Maria Carmela Annunziata & Gabriella Fabbrocini

  2. SC Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy

    Alfonso De Stefano

  3. Medical Oncology Unit, Ospedale Vito Fazzi, Lecce, Italy

    Silvana Leo

  4. Oncology Unit, Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy

    Paolo Marchetti

  5. IDI-IRCCS, Rome, Italy

    Paolo Marchetti

  6. Dermatology Unit, Ospedale S. Camillo, Rome, Italy

    Maria Concetta Romano

  7. Dermatologist, UOC Oncologia, Ospedale “Sacro Cuore di Gesù” Gallipoli - Progetto Lilt, Lecce, Italy

    Ivana Romano

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  1. Maria Carmela Annunziata
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  2. Alfonso De Stefano
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  4. Silvana Leo
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Corresponding author

Correspondence to Paolo Marchetti.

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Conflict of interest

Alfonso De Stefano received an honorarium for participation in advisory boards from Amgen. Gabriella Fabbrocini received a grant and support for travel to meetings regarding the study from LEO Pharma. Maria Carmela Annunziata, Silvana Leo, Paolo Marchetti, Maria Concetta Romano, and Ivana Romano declare no conflicts of interest.

Funding

The editorial assistance for the preparation of this review was unconditionally funded by LEO Pharma.

Ethical approval

The patients whose cases are briefly reported in this review have been treated in the setting of daily clinical practice, and not as part of a clinical study of any kind. They represent a retrospective analysis and, according to Italian law, no approval from an ethics committee or institutional review board is required.

Informed consent

Patients’ photographs were acquired during treatment according to the standard procedures of the treating dermatology unit; the patients gave their consent at the time for both the treatment and scientific diffusion of the data.

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Annunziata, M.C., De Stefano, A., Fabbrocini, G. et al. Current Recommendations and Novel Strategies for the Management of Skin Toxicities Related to Anti-EGFR Therapies in Patients with Metastatic Colorectal Cancer. Clin Drug Investig 39, 825–834 (2019). https://doi.org/10.1007/s40261-019-00811-7

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