Effects of epidermal growth factor receptor inhibitor‐induced dermatologic toxicities on quality of life

Abstract

BACKGROUND: Epidermal growth factor receptor (EGFR) inhibitors frequently result in dermatologic toxicities, including rash, xerosis, pruritus, and paronychia. Although the frequency and severity of these events have been described, their effect on health-related quality of life (QoL) remains poorly understood. By using a dermatology-specific questionnaire, the authors examined the effect of these toxicities on QoL. METHODS: Patients completed the Skindex-16, a questionnaire that measures the effects on 3 domains of QoL: symptoms, emotions, and functioning. The severity of dermatologic toxicities was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0 (NCI-CTCAE). Correlations of dermatology QoL scores with NCI-CTCAE grade, skin phototype (SPT), sex, age, type of EGFR inhibitor, and cancer type were investigated. RESULTS: Concordant with greater severity of rash grade, there was an increase in median scores for symptoms (P ¼ .0006), emotions (P < .0001), function (P ¼ .001), and overall score (P < .0001). There was an inverse correlation between age and emotions (r ¼ À0.26; P ¼ .03) and overall score (r ¼ À0.25; P ¼ .04). There was a significant difference between patients aged 50 years and patients aged >50 years with regard to symptoms (P ¼ .02), emotions (P ¼ .03), functioning (P ¼ .04), and overall score (P ¼ .02). There were no significant differences between QoL and SPT, sex, treatment type, or cancer type (P > .05). CONCLUSIONS: Toxicities, including rash, xerosis, paronychia, and pruritus, adversely affected QoL, and rash was associated with a QoL greater decrease. Younger patients reported lower overall QoL than older patients who had the same toxicities. The current results support using the NCI-CTCAE as a correlative tool for measuring the effects of rash on dermatology-specific QoL. Cancer 2010;116:3916-23.

Dermatologic adverse events associated with afatinib: an oral ErbB family blocker

“…When a dermatology-specific QoL questionnaire was Review used to assess the effect of EGFR-inhibitor-associated rash (ranging in severity from grade 1 to 3 according to the NCI-CTCAE Version 3.0) on 58 patients' well-being, emotions were found to be significantly affected more than either symptoms or function (p < 0.0001) [26]. A greater severity of rash was significantly associated with a detrimental impact on symptom (p = 0.0006), emotional (p < 0.0001) and functional (p = 0.001) aspects of the QoL questionnaire, and resulted in a negative impact on overall score (p < 0.0001) [27]. Evidence also suggests that skin-related AEs have a different impact on different patient populations; for instance, younger patients are affected to a greater degree than older patients by the presence of the same dermatologic AEs [27].…”

“…A greater severity of rash was significantly associated with a detrimental impact on symptom (p = 0.0006), emotional (p < 0.0001) and functional (p = 0.001) aspects of the QoL questionnaire, and resulted in a negative impact on overall score (p < 0.0001) [27]. Evidence also suggests that skin-related AEs have a different impact on different patient populations; for instance, younger patients are affected to a greater degree than older patients by the presence of the same dermatologic AEs [27].…”

Algorithms for Management of Patients With Adverse Events on Therapy With Tyrosine Kinase Inhibitors Egfr

“…Несмотря на ограниченные данные по фотосенсиби-лизирующему действию ИТК-EGFR, пациентам рекомен-дуется прикрывать незащищенные участки кожи и использовать солнцезащитные средства SPF 30 UVА/UVB, не образующие непроницаемую пленку, особенно при сильном солнечном воздействии [42][43][44]. В качестве средств личной гигиены, рекомендуется использовать водные смягчающие средства и заменители мыла -они в меньшей степени подсушивают кожу, чем обычное мыло; рекомендуется использовать шампуни, снижающие риск фолликулита головы, например, кетоконазол, бетадин.…”

“…рекомендаций лечащим врачам необходимо обратиться к действующей инструкции для каждого ИТК-EGFR [39][40][41][42][43]45]. Лечение ИТК-EGFR может быть возобновлено только в случае регрессирования сыпи до ≤ 2 степени [39][40][41].…”

“…В исследованиях III фазы у 25-95% пациентов наблю-дались НЯ любой степени и 1-14% -НЯ ≥3 степени (табл. 9) [11][12][13][14][15][16][17][18][19][20][39][40][41][42][43][44][45][46][47][48].…”