Cetuximab-induced skin exanthema: Improvement by a reactive skin therapy

Abstract

Abstract. More than 80% of patients treated with cetuximab develop an acneiform follicular skin exanthema. Grade 3 exanthema develops in 9-19% of these cases, bearing the risk of cetuximab dose-reduction or cessation. We retrospectively analysed a cohort of 20 patients treated with cetuximab and an in-house reactive skin protocol upon development of an exanthema. The reactive skin protocol was built up as follows: grade 1 exanthema: topical cleansing syndet (dermowas ® ) + topical metronidazole cream (rosiced ® ); grade 2 exanthema: grade 1 treatment + oral minocycline 50 mg twice per day; grade 3 exanthema: grade 2 treatment + topical corticoid (dermatop ® ) + topical nadifloxacin (Nadixa ® ). as soon as a grade 3 had improved to a grade less than or equal to 2, the application of the topical corticoid was ceased. during the initial 12 weeks of therapy with cetuximab, all patients developed a skin exanthema (20/20; 100%). of these, 2 patients (10%) developed a grade 3 exanthema, 10 patients (50%) experienced a grade 2 and 8 patients (40%) a grade 1 exanthema. Time to onset ranged from 1 to 4 weeks, with the average time to onset being 2.8 weeks. applying the reactive skin protocol after the first occurrence of an exanthema, the grade of exanthema was downgraded as follows: no patients (0%) had a persisting grade 3 exanthema, while only 2 patients (10%) experienced a persisting grade 2 exanthema and 8 patients (40%) a persisting grade 1 exanthema. in the majority of cases (10 patients; 50%), the reactive skin protocol completely controlled the exanthema (grade 0). The average time to exanthema reduction by one grade was 9.5 days. no dose reductions of cetuximab were necessary. cetuximab-induced skin exanthema is effectively managed by applying our reactive protocol. The simple protocol is based on a topical cleansing syndet and topical metronidazole and is to be intensified by the addition of oral minocycline, a topical corticoid and topical nadifloxacine, in cases of high-grade exanthema. More comprehensive results are expected from a prospective study with higher patient numbers that is currently being planned. Introductionepidermal growth factor receptor (eGFr) inhibitors are used as highly effective therapies for diverse tumour entities, including colorectal, head and neck, non-small cell lung and pancreatic cancers, among other malignancies (1-5). although eGFr inhibitors, such as cetuximab, are generally well tolerated and do not increase the classical adverse events of chemotherapy, they induce a skin exanthema that occurs in more than 80% of patients (1,4). While the exanthema has an acneiform appearance, its origin is nonetheless follicular (5). This follicular acneiform exanthema presents itself as maculae, papulae or small pustulae occurring on the face, décolleté or back, and may be accompanied by symptoms, such as burning or itching.Time to onset is between 2 and 3 weeks after the first application of the eGFr inhibitor. While the majority of patients develop only mild exanthemas (grades 1 or 2), 9-...

Phase II trial of panitumumab with irinotecan as salvage therapy for patients with advanced or recurrent colorectal cancer (TOPIC study)

“…The lack of a reactive skin program also could be a bias point of this trial. Certain investigators have reported that intensive reactive skin therapy is enough for skin toxicities (26).…”

A Preliminary Study Examining the Correlation between EGFRI Treatment, Clinic Dermatoscopy Features, and Serum Levels of Anti-Alpha-Galactosyl IgE in Colorectal Cancer Patients

“…In severe cases, reducing the dosage or stopping the therapy might be necessary. Interestingly, the development and severity of this rash are linked to a better prognosis, causing concern for patients who might have to discontinue Cetuximab due to side effects [19]. Moreover, there are limited data available regarding preventive measures or treatments specifically for this acne-like rash, primarily extrapolated from acne treatment methods [20].…”