The incidence and management of cutaneous adverse events of the epidermal growth factor receptor inhibitors

Abstract

Overexpression of the epidermal growth factor receptor (EGFR) is found in many cancers, including those of the head and neck area, non-small-cell lung cancer, and colorectal, cervical, prostate, breast, ovary, stomach, and pancreatic cancer. The EGFR inhibitors are used at present in the treatment of such cancers. Skin lesions that develop during and after cancer treatment may be due to specific cytostatics, molecular-targeted drugs, radiation therapy, complementary therapy, or the cancer itself, and hence knowledge is essential to distinguish between them. The mechanism through which skin toxicity arises during treatment with EGFR inhibitors is not well known, but seems to be due to the modification of the RAS/RAF/MEK/ERK signal path associated with its activation, which results in the similarity between the adverse effects of EGFR inhibitors and the treatment of melanoma with BRAF and MEK inhibitors. The most common side effects are pruritus, xerosis, papulopustular rash, hand-foot skin reaction, alopecia and dystrophy of the hair, and paronychia. This work presents options for prevention and suggestions for managing these adverse events, which are of importance in the care of patients undergoing oncological treatment.

Antitumor pharmacotherapy of colorectal cancer in kidney transplant recipients

“…Given the fact that EGFR is expressed in skin and adnexal structures, EGFR inhibitors are associated with skin toxicity, mainly acneiform eruption and xerosis, but also paronychia, abnormal scalp, facial hair, and eyelash growth, maculopapular rash, mucositis, and postinflammatory hyperpigmentation. 113,114 PRIDE syndrome comprises the most frequent reactions associated with anti-EGFR reactions (papules, pustules, paronychia, hair growth disorders, pruritus, and skin and mucosal xerosis). 114 In a recent meta-analysis involving 38 studies, any grade skin toxicities were identical in cetuximab and panitumumab (83.6% versus 84.4%; p = 0.99).…”

Dermatological adverse effects in a cancer patient treated with an EGFR inhibitor. Case report and literature review

“…It is worth emphasizing that a positive correlation between the occurrence and severity of some skin symptoms, and the degree of response to oncological treatment and prolonged survival time has been demonstrated [2,16]. For that reason it is important to know adverse effects that may develop following the use of modern anti-cancer treatments, means of appropriate prevention, and early introduction of an appropriate treatment if need be.…”

“…Warto podkreślić, że udowodniono pozytywną korelację między wystąpieniem i nasileniem niektórych objawów skórnych a stopniem odpowiedzi na leczenie onkologiczne oraz wydłużeniem czasu przeżycia [2,16]. Z tego powodu istotne są znajomość objawów niepożądanych, które mogą wystąpić po zastosowaniu nowoczesnych leków onkologicznych, odpowiednia profilaktyka, a w razie potrzeby szybkie wdrożenie właściwego leczenia.…”

An update on Chinese herbal medicines as adjuvant treatment of anticancer therapeutics

“…With molecular-targeted drugs especially epidermal growth factor receptor-tyrosine kinase inhibitors (EGFRTKIs) (e.g., Gefitinib and Afatinib) widely used, adverse effects of such treatments including acneiform eruptions, paronychia, xerosis, mucositis, and alopecia are thought to be less severe, but can still be significant (6). Not only can these toxicities severely affect patients' QOL, but in some specific instances, they can be associated with increased response to therapy.…”

“…However, these therapies either alone or in combination have been shown to have numerous limitations and drawbacks including myelosuppression, gastrointestinal tract reaction, cardiac damage, liver and renal dysfunction, rash, hand-foot syndrome, or local radiation damage, and so on (4,5). In particular, with molecular-targeted drugs widely used, adverse effects of such treatments including acneiform eruptions, paronychia, xerosis, mucositis, and alopecia are thought to be less severe, but can still be significant (6). Not only can these toxicities severely affect patients' QOL, but in some specific instances, they can be associated with increased response to therapy (7).…”