A survey of patient and physician acceptance of skin toxicities from anti-epidermal growth factor receptor therapies

Abstract

BackgroundInhibition of the epidermal growth factor receptor (EGFR) extends patient survival in multiple tumor types. Skin toxicities are the most common adverse event (AE) elicited by EGFR inhibitors. Here, we provide deeper insights into patients’ and physicians’ acceptance of the risk/benefit trade-offs of skin toxicities during cancer therapy, including comparison of their perceptions and experiences with dermatologic AEs.MethodsA multinational survey of 195 patients and 120 physicians was conducted to gauge attitudes regarding skin toxicities as an AE during cancer therapy.ResultsSkin toxicities were identified by patients and physicians as the AE that is most discouraging to patients when undergoing cancer therapies. Skin toxicities were cited as causing pain, impairing quality of life, and proving difficult to manage. Despite these negative influences, the majority of patients (71%) indicated they were willing to accept skin toxicities as an AE of an effective therapy. Indeed, the majority of patients and physicians preferred a more effective therapy that induces more severe skin toxicities than a less efficacious therapy that induces less severe skin toxicities; interestingly, patients were willing to accept a higher likelihood of severe skin toxicities than physicians.ConclusionIn this examination of patients’ perspectives, we found that patients were willing to accept skin toxicities if they were the anticipated byproduct of a more effective therapeutic regimen. Important differences were observed between patients’ and physicians’ attitudes regarding risk/benefit trade-offs during cancer therapy, suggesting that patient’s considerations and shared decision-making are key to cancer care.Electronic supplementary materialThe online version of this article (10.1007/s00520-017-3938-7) contains supplementary material, which is available to authorized users.

Impact of cutaneous adverse events on the quality of life in patients receiving anticancer agents: Results from an observational, cross-sectional study

“…In our study, pruritus, xerosis and PPE were the most frequent CAE, followed by alopecia and papulopustular rash. Ungual apparatus changes, rash, HFSR, and pigmentary changes were also common [1][2][3][4][5][6][7]35]. In a clinical trial using EGFRI, Joshi et al reported that the most common skin toxicities were rash, xerosis, paronychia, and pruritus [30].…”

“…Skin is one of the organs that is most frequently affected by molecularly targeted drugs [3][4][5][6][10][11][12][13][14][15] [34]. These discrepancies may be due to differences in study designs and PRO instruments used to evaluate QoL and highlight the interest of addressing this topic.…”

“…Many studies have demonstrated that new agents, including targeted therapies, offer better disease control and survival rates compared to classical cytotoxic chemotherapies. [1][2][3][4][5][6]. Concurrently, new drugs usually mean new adverse event pro les, including cutaneous adverse events (CAEs) [10][11][12][13][14][15].…”

Genomics models in radiotherapy: From mechanistic to machine learning

“…Second, RP2 may be an overly conservative endpoint as CTCAE v3.0 Grade 2 pneumonitis is defined as “symptomatic, not interfering with ADL.” This issue relates to the differing weights that patients and physicians place on LC and toxicity. Patients may value LC more than toxicity due to fear of recurrence whereas physicians may weigh toxicity more than LC . Whereas a tumor recurrence may be attributed to aggressive biology, physicians can be more certain of therapy‐induced toxicity, which can induce recall bias of patients who had severe toxicity.…”

Results of the non-small cell lung cancer part of a phase III, open-label, randomized trial evaluating topical corticosteroid therapy for facial acneiform dermatitis induced by EGFR inhibitors: stepwise rank down from potent corticosteroid (FAEISS study, NCCH-1512)

“…The incidence of facial acneiform rash of all grades has been estimated to be 60-90% from previous clinical trials [11,12]. Although these adverse reactions are rarely serious or life-threatening, skin toxicity can significantly affect quality of life (QOL), causing both physical discomfort and psychological distress, which can affect compliance, thus affecting the efficacy of treatment with EGFR inhibitors [13][14][15][16]. Therefore, proper management of these toxicities is essential.…”