Duration of Oral Antibiotics Administration for Cetuximab-Induced Acneiform Eruption

Abstract

<b><i>Background:</i></b> Acneiform eruption is the most common cutaneous adverse event associated with cetuximab. As it can affect quality of life and adversely affect chemotherapy schedule, additional medical care is required. <b><i>Objectives:</i></b> To investigate the adherence to and the duration of antibiotic administration to treat cetuximab-induced acneiform eruption. <b><i>Methods:</i></b> Medical data of patients who were referred to the Department of Dermatology were reviewed from January 2013 to June 2018. Dermatologists assessed the severity of acneiform eruption and prescribed tetracycline-class antibiotics according to the severity every 2 or 4 weeks. We investigated the duration and amount of oral antibiotic administration and analyzed the factors that may affect the control of acneiform eruption statistically. <b><i>Results:</i></b> A total of 207 of 267 patients referred to the Department of Dermatology showed acneiform eruption; 124 patients were treated with minocycline, 34 patients with doxycycline, 27 patients with both, and 22 patients with topical agents. The mean duration of oral antibiotic medication was 82.7 days. A statistical analysis of the factors that prolonged the use of antibiotics for more than 90 days showed that male and younger age were risk factors. Shorter time interval from starting cetuximab to starting antibiotics was associated with longer duration of antibiotic use, statistically. <b><i>Conclusions:</i></b> Cetuximab-induced acneiform eruption can be well controlled with tetracycline-class antibiotics in about 3 months. It can last longer in male and younger patients. The sooner and the more severe it appears, the longer it can last.

Cutaneous toxicities from targeted therapies used in oncology: Literature review of clinical presentation and management

“…For grade 1/2 rash, initiation or continuation of oral tetracycline antibiotics and topical corticosteroids for at least 6 weeks is recommended ( Table 3 ; Lacouture et al, 2021a ). The mean treatment duration to control the eruption is 3 months ( Park et al, 2021 ). For a grade 3 rash, in addition to the previous measures, a short course of systemic corticosteroids is suggested, with an interruption of the targeted therapy until the rash resolves to grade 0/1.…”

A Commentary on the “Duration of Oral Antibiotics Administration for Cetuximab-Induced Acneiform Eruption”

“…Cetuximab is a monoclonal antibody that inhibits the epidermal growth factor receptor (EGFR) present on the surface of various cancer cells [1]. It is a widely used drug as it has increased the treatment response rate for cancers including squamous cell carcinoma of the head and neck along with metastatic colorectal cancer (CRC), the third most diagnosed cancer globally [1]. However, it commonly causes acneiform eruption, a papulopustular eruption on the face, scalp, upper chest, and back, a distressing cutaneous side effect [1].…”

“…A few noteworthy limitations were identified including an inadequate number of participants ( n = 207 patients), due to data only being gathered from 2013 to 2018, which is not enough to extrapolate to the general population [1]. Also, the number of patients treated with different types of tetracycline were not equal (124 with minocycline, 34 with doxycycline, 27 with both and 22 with topical agents) [1]. This results in an inconclusive comparison between the effectiveness of each type of tetracycline antibiotics.…”

“…This results in an inconclusive comparison between the effectiveness of each type of tetracycline antibiotics. As for the treatment of acneiform eruption, not all drug switches were identified and reported on the medical record, making the effectiveness of a specific type of antibiotic highly questionable [1]. Also, it was not mentioned which type of tetracycline specifically caused the side effects mentioned, such as gastrointestinal discomfort and insufficient drug effects [1].…”

“…Also, this study was not limited to cetuximab used for a specific type of cancer [1]. Therefore, it permitted the discovery of a relationship between the type of cancer and the prevalence of CIAE [1]. CRC patients were shown to most commonly have CIAE ( n = 91.4%) [1].…”