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

Gerber PA, Meller S, Eames T, Buhren BA, Schrumpf H, Hetzer S, Ehmann LM, Budach W, Bölke E, Matuschek C, Wollenberg A, Homey B - Eur. J. Med. Res. (2012)

Bottom Line: In recent years inhibitors directed against the epidermal growth factor receptor (EGFR) have evolved as effective targeting cancer drugs.Yet, an effective dermatologic management of cutaneous adverse effects can be achieved.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Dermatology, University of Duesseldorf, Medical Faculty, Moorenstrasse 5, D-40225 Duesseldorf, Germany. peterarne.gerber@uni-duesseldorf.de

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.

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Severity of EGFRI-induced papulopustular rashes. Rash severity was assessed using the EGFRI-induced rash severity score (ERSS). ERSSs may range from 0 (no skin affection), over (A) 1 to 20 (mild), (B) 20 to 40 (moderate), up to (C) scores exceeding 40 points, indicating severe cases.
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Figure 1: Severity of EGFRI-induced papulopustular rashes. Rash severity was assessed using the EGFRI-induced rash severity score (ERSS). ERSSs may range from 0 (no skin affection), over (A) 1 to 20 (mild), (B) 20 to 40 (moderate), up to (C) scores exceeding 40 points, indicating severe cases.

Mentions: Rash severity was assessed during the initial presentation to our clinics (Departments of Dermatology, University Hospital Düsseldorf and Ludwig-Maximilian-University of Munich) and after three weeks of specific dermatologic therapy. Rash severity was assessed applying the EGFRI-induced rash severity score (ERSS or WoMoScore), a skin-specific scoring system introduced in 2008 [26]. Briefly, the ERSS is a combined score of the severity of five different aspects of the EGFRI-rash (color of erythema, distribution of erythema, papulation, pustulation and scaling/crusts), combined with a score based on the extent of affected facial area and the total body area involved. ERSSs range from 0 (no skin affection), 1 to 20 (mild), between 20 and 40 (moderate), up to scores exceeding 40 points, indicating severe cases (Figure 1) [26].


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

Gerber PA, Meller S, Eames T, Buhren BA, Schrumpf H, Hetzer S, Ehmann LM, Budach W, Bölke E, Matuschek C, Wollenberg A, Homey B - Eur. J. Med. Res. (2012)

Severity of EGFRI-induced papulopustular rashes. Rash severity was assessed using the EGFRI-induced rash severity score (ERSS). ERSSs may range from 0 (no skin affection), over (A) 1 to 20 (mild), (B) 20 to 40 (moderate), up to (C) scores exceeding 40 points, indicating severe cases.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3351712&req=5

Figure 1: Severity of EGFRI-induced papulopustular rashes. Rash severity was assessed using the EGFRI-induced rash severity score (ERSS). ERSSs may range from 0 (no skin affection), over (A) 1 to 20 (mild), (B) 20 to 40 (moderate), up to (C) scores exceeding 40 points, indicating severe cases.
Mentions: Rash severity was assessed during the initial presentation to our clinics (Departments of Dermatology, University Hospital Düsseldorf and Ludwig-Maximilian-University of Munich) and after three weeks of specific dermatologic therapy. Rash severity was assessed applying the EGFRI-induced rash severity score (ERSS or WoMoScore), a skin-specific scoring system introduced in 2008 [26]. Briefly, the ERSS is a combined score of the severity of five different aspects of the EGFRI-rash (color of erythema, distribution of erythema, papulation, pustulation and scaling/crusts), combined with a score based on the extent of affected facial area and the total body area involved. ERSSs range from 0 (no skin affection), 1 to 20 (mild), between 20 and 40 (moderate), up to scores exceeding 40 points, indicating severe cases (Figure 1) [26].

Bottom Line: In recent years inhibitors directed against the epidermal growth factor receptor (EGFR) have evolved as effective targeting cancer drugs.Yet, an effective dermatologic management of cutaneous adverse effects can be achieved.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Dermatology, University of Duesseldorf, Medical Faculty, Moorenstrasse 5, D-40225 Duesseldorf, Germany. peterarne.gerber@uni-duesseldorf.de

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.

Show MeSH
Related in: MedlinePlus