Management of EGFR-inhibitor associated rash: a retrospective study in 49 patients

Abstract

Background In recent years inhibitors directed against the epidermal growth factor receptor (EGFR) have evolved as effective targeting cancer drugs. Characteristic papulopustular exanthemas, often described as acneiform rashes, are the most frequent adverse effect associated with this class of novel cancer drugs and develop in > 90% of patients. Notably, the rash may significantly compromise the patients' quality of life, thereby potentially leading to incompliance as well as dose reduction or even termination of the anti-EGFR therapy. Yet, an effective dermatologic management of cutaneous adverse effects can be achieved. Whereas various case reports, case series or expert opinions on the management of EGFR-inhibitor (EGFRI) induced rashes have been published, data on systematic management studies are sparse. Methods Here, we present a retrospective, uncontrolled, comparative study in 49 patients on three established regimens for the management of EGFRI-associated rashes. Results Strikingly, patients' rash severity improved significantly over three weeks of treatment with topical mometason furoate cream, topical prednicarbate cream plus nadifloxacin cream, as well as topical prednicarbate cream plus nadifloxacin cream plus systemic isotretinoin. Conclusions In summary our results demonstrate that EGFRI-associated rashes can be effectively managed by specific dermatologic interventions. Whereas mild to moderate rashes should be treated with basic measures in combination with topical glucocorticosteroids or combined regiments using glucocorticosteroids and antiseptics/antibiotics, more severe or therapy-resistant rashes are likely to respond with the addition of systemic retinoids.

Adverse reactions to targeted and non-targeted chemotherapeutic drugs with emphasis on hypersensitivity responses and the invasive metastatic switch

“…5 Small molecule EGFR tyrosine kinase inhibitors such as erlotinib, gefitinib and sorafenib often provoke characteristic inflammatory papulopustular exanthemas described as acneiform or rosaceaform rashes. These are the most frequently seen cutaneous reactions to these drugs occurring in more than 90 % of patients in the first days-weeks of therapy [152,154,155]. The photographs show increasing degrees of severity of rashes based on a scoring system that takes into account colour and distribution of erythema, papulation, pustulation and scaling/crusts: a mild rash; b moderate rash; c severe rash (reproduced from Gerber et al [154], an Open Access article distributed under the terms of the Creative Commons Attribution License) disease and is seen predominantly as hepatitis and/or cholestasis [217].…”

EGFRI‐induced papulopustular rosacea‐like rash successfully treated with topical ivermectin

“…In a retrospective study of 49 patients, the EGFR inhibitor-associated rash significantly improved under nadifloxacin 1% cream, a potent fluoroquinolone, associated with prednicarbate 0.25% cream. 6 Systemic minocycline or doxycycline (100 mg/day) has also a high level of evidence. 1 Low-dose oral isotretinoin (0.1 mg to 0.2 mg/kg) was effectively used in severe rash.…”

Exogenous acnegens and acneform eruptions

“…Litt's Drug Eruptions and Reactions Manual lists 210 such medications from acamprosate to zonisamide [2]. Variants of anti-acne and anti-inflammatory therapy are in use [3,4]. 4.5).…”