Evaluation of a Comprehensive Skin Toxicity Program for Patients Treated With Epidermal Growth Factor Receptor Inhibitors at a Cancer Treatment Center

Abstract

Up to 90% of patients treated with an epidermal growth factor receptor inhibitor (EGFRi) experience cutaneous toxic effects that are negatively associated with quality of life and lead to treatment interruptions. The Skin Toxicity Evaluation Protocol With Panitumumab trial found reduced incidence of skin toxicity and quality of life impairment with preemptive use of doxycycline hyclate, topical corticosteroids, moisturizers, and sunscreen, demonstrating the benefit of prophylactic treatment for skin toxicity.OBJECTIVE To evaluate the association of a comprehensive skin toxicity program with adherence to prophylaxis guidelines for the prevention of EGFRi-associated cutaneous toxic effects. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study was conducted of all adult patients receiving at least 1 dose of cetuximab at the Dana-Farber Cancer Institute in the calendar year 2012 (2 years after publication of the Skin Toxicity Evaluation Protocol With Panitumumab) or the calendar year 2017 (2 years after full implementation of the Skin Toxicities from Anticancer Therapies program). MAIN OUTCOMES AND MEASURESPrimary outcomes were rate of preemptive rash treatment and selection of preemptive agents. Secondary outcomes were incidence of rash, rates of rescue treatments, rates of cetuximab dose changes or interruptions, and overall survival at 2 years. RESULTSThere were 118 patients (85 men; median age, 62.4 years [range, 23.5-91.7 years]) treated with cetuximab in 2012 and 90 patients (70 men; median age, 62.5 years [range, 30.7-90.5 years]) treated with cetuximab in 2017; 11 patients (9%) in 2012 and 31 patients (34%) in 2017 were treated at Dana-Farber Cancer Institute affiliate sites. At cetuximab treatment initiation, 29 patients (25%) in 2012 and 42 patients (47%) in 2017 were prophylactically treated for skin toxicity (P < .001). From 2012 to 2017, preemptive tetracycline use (13 of 29 [45%] to 30 of 42 [71%]; P = .02) and topical corticosteroid use (2 of 29 [7%] to 24 of 42 [57%]; P < .001) increased and topical antibiotic use (23 of 29 [79%]to 18 of 42 [43%]; P = .002) decreased. There was no significant difference in incidence of rash by prophylaxis status. Patients prescribed prophylactic treatment were 94% less likely to require a first rescue treatment for rash (adjusted odds ratio, 0.06; 95% CI, 0.02-0.16; P < .001), 74% less likely to require a second rescue treatment for rash (adjusted odds ratio, 0.26; 95% CI, 0.08-0.83; P = .02), and 79% less likely to experience a cetuximab dose change or interruption (adjusted odds ratio, 0.21; 95% CI, 0.06-0.81; P = .02) than patients not prescribed prophylactic treatment, adjusting for treatment site and year.CONCLUSIONS AND RELEVANCE Dermatologists can add value to oncology care by raising awareness of appropriate treatment options and increasing adherence to evidence-based prophylaxis protocols for EGFRi-associated rash, which is associated with decreased interventions and toxicity-associated chemotherapy interruptions.

Duration of Oral Antibiotics Administration for Cetuximab-Induced Acneiform Eruption

“…The reason for this interval may be that referral to dermatologists is delayed until patients feel uncomfortable or acneiform eruption gets worse to CTCAE grade 2 or higher. The duration of minocycline or doxycycline medication was 82.7 days, which was similar to the 6 or 8 weeks recommended by previous studies [15,25]. There was no statistical difference in duration between doxycycline and minocycline treatments.…”

US Cutaneous Oncodermatology Management (USCOM): A Practical Algorithm

“…Many studies are available on cAEs; however, more robust studies are needed on prevention, treatment, and maintenance using skincare. [5][6][7][8][9][10][11][12][17][18][19][20]22,25,29,39 cAEs negatively affect functional and emotional domains relating to QoL in cancer patients. Moreover, multiple negative experiences due to cAEs may increase psychological distress and avoidance of personal relationships, leading to social isolation.…”

Efficacy and Safety of Modified Huang-Lian-Jie-Du Decoction Cream on Cancer Patients with Skin Side Effects Caused by EGFR Inhibition

“…Among these treatments, antibacterial drugs and steroids are the most prescribed regimens for the treatment and prevention of EGFRIs/TKIs-induced skin reactions [3]. According to a retrospective cohort study, integrating dermatologic care of evidence-based prophylaxis treatment may minimize skin toxicity-associated chemotherapy interruptions [4]. However, some patients still had skin toxicity after antibacterial treatment.…”