Dermatologic events from EGFR inhibitors: the issue of the missing patient voice

Abstract

PurposeAs epidermal growth factor receptor (EGFR) inhibitors are associated with a variety of dermatologic adverse events (dAEs), the purpose of this study was to develop an overview of current knowledge of dAEs associated with EGFR inhibitors and to identify knowledge gaps regarding incidence, treatment, impact on quality of life (QOL), and patient acceptance.MethodA structured literature search was conducted using MEDLINE/PubMed (January 1983 to January 2014). In total, 71 publications published from 2004 to 2014 were identified for consideration in the final evidence review.ResultsThe majority of published articles concentrate on the incidence of skin reactions, duration, treatment, and prevention strategies. Different grading systems based on the symptoms of skin rash or on health-related QOL (HRQOL) are used. An additional topic is the possible correlation between acneiform rash and efficacy of EGFR inhibitors. Knowledge gaps identified in the literature were how dAEs impact QOL compared with other AEs from a patient’s perspective, patients’ acceptance of dAEs (willingness to tolerate), and the impact of physician-patient communication on treatment decisions.ConclusionsResearch is needed on the impact of dAEs on patients’ acceptance of cancer treatments. Systematic studies are missing that compare the impact of dAEs with other toxicities on therapy decisions from both physician’s and patient’s view, and that investigate the balance between efficacy and avoidance of acneiform rash in treatment decisions. Such studies could provide deeper insights into the acceptance of the risk of untoward dermatologic events by both physicians and patients when treating advanced cancers.Electronic supplementary materialThe online version of this article (doi:10.1007/s00520-016-3419-4) contains supplementary material, which is available to authorized users.

Impact of cutaneous adverse events on the quality of life in patients receiving anticancer agents: Results from an observational, cross-sectional study

“…In our study, pruritus, xerosis and PPE were the most frequent CAE, followed by alopecia and papulopustular rash. Ungual apparatus changes, rash, HFSR, and pigmentary changes were also common [1][2][3][4][5][6][7]35]. In a clinical trial using EGFRI, Joshi et al reported that the most common skin toxicities were rash, xerosis, paronychia, and pruritus [30].…”

“…Many studies have demonstrated that new agents, including targeted therapies, offer better disease control and survival rates compared to classical cytotoxic chemotherapies. [1][2][3][4][5][6]. Concurrently, new drugs usually mean new adverse event pro les, including cutaneous adverse events (CAEs) [10][11][12][13][14][15].…”

Severe Pain Due to Paraspinal Abscess Formation in Two Patients with Squamous-Cell Carcinoma of the Head and Neck after Multimodal Treatment Including Cetuximab

“…Cutaneous and mucosal reactions are dominant side effects, which can usually be managed easily [5]. However, 45-100% of patients acquire an acneiform rash, and only a minority develops dermatitis or higher-grade skin toxicities, but little is known about the impact this may have on the individual [6]. The onset is typically a few days after therapy, with a peak about 2 weeks after.…”

“…Immunogenic effects of anti-EGFR mAbs interfering with ADCC in bacterial defense could be considered beyond the well-known antiproliferative effects of EGFR inhibitors on non-mutated tissue. Moreover, the patient's burden as well as the economic burden even of non-life-threatening side effects may be considerable [6,19]. …”

Quality of Life for Patients with Advanced Basal Cell Carcinoma Treated with Hedgehog Signaling Pathway Inhibitors

“…Unlike some targeted therapies used for other types of cancer (eg, sorafenib, imatinib), which can cause multiple cutaneous AEs (eg, hypopigmentation, maculopapular rash, epidermoid cysts) [31,32], hedgehog signaling pathway inhibitors primarily produce alopecia as a cutaneous AE [32]. Common noncutaneous AEs from hedgehog inhibitors include muscle spasm, dysgeusia, fatigue, and nausea [20,23].…”