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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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Related in: MedlinePlus

Significant improvement of rash severity under specific dermatologic measures. (A) Topical mometason furoate cream significantly (P = 0.0009) improved the severity of the skin rash (ERSS) in patients treated with EGFRI after three weeks. (B) A combined topical regimen with prednicarbate cream and nadifloxacin cream significantly (P = 0.03) improved the ERSS in patients treated with EGFRI after three weeks. (C) A triple therapy with topical prednicarbate cream, topical nadifloxacin cream and systemic isotretinoin significantly (P = 0.015) improved the ERSS in patients treated with EGFRI after three weeks. Statistical analyses were performed applying the Student's t-test.
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Figure 2: Significant improvement of rash severity under specific dermatologic measures. (A) Topical mometason furoate cream significantly (P = 0.0009) improved the severity of the skin rash (ERSS) in patients treated with EGFRI after three weeks. (B) A combined topical regimen with prednicarbate cream and nadifloxacin cream significantly (P = 0.03) improved the ERSS in patients treated with EGFRI after three weeks. (C) A triple therapy with topical prednicarbate cream, topical nadifloxacin cream and systemic isotretinoin significantly (P = 0.015) improved the ERSS in patients treated with EGFRI after three weeks. Statistical analyses were performed applying the Student's t-test.

Mentions: In this study we sought to compare the effectiveness of established rash management strategies. Therefore, we first assessed the efficacy of a potent anti-inflammatory topical glucocorticosteroid with low-atrophogenic potential [28]. Twenty-one patients (ERSS ranging from 10.3 to 77.9) were treated with mometason furoate cream. Assessment of the ERSS prior to therapy initiation and after three weeks revealed that the mean rash severity improved significantly (P = 0.00009) from 45.9 to 27.0 and demonstrated the efficacy of our approach (Figure 2A).


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)

Significant improvement of rash severity under specific dermatologic measures. (A) Topical mometason furoate cream significantly (P = 0.0009) improved the severity of the skin rash (ERSS) in patients treated with EGFRI after three weeks. (B) A combined topical regimen with prednicarbate cream and nadifloxacin cream significantly (P = 0.03) improved the ERSS in patients treated with EGFRI after three weeks. (C) A triple therapy with topical prednicarbate cream, topical nadifloxacin cream and systemic isotretinoin significantly (P = 0.015) improved the ERSS in patients treated with EGFRI after three weeks. Statistical analyses were performed applying the Student's t-test.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Significant improvement of rash severity under specific dermatologic measures. (A) Topical mometason furoate cream significantly (P = 0.0009) improved the severity of the skin rash (ERSS) in patients treated with EGFRI after three weeks. (B) A combined topical regimen with prednicarbate cream and nadifloxacin cream significantly (P = 0.03) improved the ERSS in patients treated with EGFRI after three weeks. (C) A triple therapy with topical prednicarbate cream, topical nadifloxacin cream and systemic isotretinoin significantly (P = 0.015) improved the ERSS in patients treated with EGFRI after three weeks. Statistical analyses were performed applying the Student's t-test.
Mentions: In this study we sought to compare the effectiveness of established rash management strategies. Therefore, we first assessed the efficacy of a potent anti-inflammatory topical glucocorticosteroid with low-atrophogenic potential [28]. Twenty-one patients (ERSS ranging from 10.3 to 77.9) were treated with mometason furoate cream. Assessment of the ERSS prior to therapy initiation and after three weeks revealed that the mean rash severity improved significantly (P = 0.00009) from 45.9 to 27.0 and demonstrated the efficacy of our approach (Figure 2A).

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