Management of Skin Reactions During Cetuximab Treatment in Association With Chemotherapy or Radiotherapy

Pinto, Carmine; Barone, Carlo; Girolomoni, Giampiero; Russi, Elvio; Merlano, Marco; Ferrari, Daris; Maiello, Evaristo

doi:10.1097/coc.0000000000000291

Cited by 29 publications

(28 citation statements)

References 47 publications

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“…One of the problems hindering the effective management of EGFRI-associated dermatological toxicities is the use of inaccurate and inconsistent toxicity evaluation criteria 15. Previously available tools were not designed for reporting EGFRI-associated dermatological events, and this resulted in underreporting and poor grading of side effects.…”

Section: Introductionmentioning

confidence: 99%

Skin toxicity evaluation in patients treated with cetuximab for metastatic colorectal cancer: a new tool for more accurate comprehension of quality of life impacts

Tursi¹,

Zilli²,

Carella³

et al. 2017

OTT

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ObjectivesThe effectiveness of evaluation of the severity of epidermal growth-factor receptor inhibitor (EGFRI)-associated dermatological toxicities remains a topic of debate. This study was designed to assess the correlation between quality of life (QoL) and severity of dermatological toxicity, evaluated using the National Cancer Institute’s Common Terminology Criteria for Adverse Events (NCI-CTCAE) and our novel scale, the Eruption Scoring System (ESS), in metastatic colorectal cancer (CRC) patients treated with first-line chemotherapy combined with cetuximab.MethodsCutaneous toxicity was evaluated, by oncologists and dermatologists, in patients (n=30) with histologically confirmed metastatic CRC who were scheduled to begin first-line chemotherapy combined with the EGFRI, cetuximab, using the NCI-CTCAE and ESS tools. Health-related QoL (HRQoL) was evaluated using the Skindex-29 and Skindex-17 dermatology-specific instruments. Correlations between QoL and skin toxicity severity were assessed using Spearman’s rank tests. Interclass correlation coefficients were used to assess interoperator agreement for ESS and NCI-CTCAE v4.0 scoring.ResultsA positive correlation was identified between dermatology HRQoL and the severity of dermatological toxicities assessed using the NCI-CTCAE v4.0 scale for cutaneous papulopustular acneiform rash; however, a stronger correlation was observed between HRQoL and toxicities evaluated using the ESS tool. Both NCI-CTCAE v4.0 and ESS tools demonstrated good interobserver agreement for grading of skin toxicity.ConclusionThere is a strong correlation between the scores generated by the ESS and NCI-CTCAE tools to grade cutaneous toxicity related to treatment with the anti-EGFR monoclonal antibody, cetuximab. ESS can be considered a valid instrument for identification and grading of the severity of skin toxicity induced by cetuximab, with some advantages over the standard NCI-CTCAE scoring system.

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Section: Introductionmentioning

confidence: 99%

Skin toxicity evaluation in patients treated with cetuximab for metastatic colorectal cancer: a new tool for more accurate comprehension of quality of life impacts

Tursi¹,

Zilli²,

Carella³

et al. 2017

OTT

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“…The most characteristic toxicity associated with cetuximab is an acne-like rash, tha develops in up to 90% of patients and is dose-related (72,73). It usually manifests within the first 2 weeks of therapy and is characterized by a maculopapular eruption localized to face and trunk, areas with high density of seborrheic glands.…”

Section: Safety and Tolerabilitymentioning

confidence: 99%

“…Other skin toxicities are also common but rarely high grade with cetuximab, including xerosis, paronychia, hair growth abnormalities including alopecia and trichomegaly of the eyelashes/hypertrichosis of the face, and telangiectasias (72,77). Topical or oral antibiotics (macrolides, clindamycin or tetracyclines), topical corticosteroids and vitamin K creams can be employed to control severity (72). Other common toxicities are fatigue, fever, nausea, diarrhea, which are probably unrelated to dose or number of cycles administered (73).…”

Section: Safety and Tolerabilitymentioning

confidence: 99%

Cetuximab for treating non-small cell lung cancer

Mazzarella

Guida

Curigliano

2018

Expert Opinion on Biological Therapy

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Epidermal Growth Factor Receptor (EGFR)-dependent signaling plays a crucial role in epithelial cancer biology, and dictated the development of several targeting agents. The mouse-human chimeric antibody Cetuximab was among the first to be developed. After about two decades of clinical research it has gained a significant place in the management of advanced colorectal and head and neck cancers, whereas its development in non small cell lung cancer (NSCLC) has not led to a place in routine clinical practice, because of marginal clinical benefit despite statistically significant Phase III trials. Recent data from ongoing trials suggest that more careful selection based on molecular markers may identify good responders. Areas covered: In this article, the authors review the literature concerning basic science studies identifying EGFR as a therapeutic target, pharmacological development of Cetuximab, its pharmacodynamics and pharmacokinetics, and clinical trials on Cetuximab in NSCLC, focusing on recent findings on putative predictive biomarkers. Expert opinion: Cetuximab currently has no role in NSCLC treatment outside of research settings. We argue that failure to identify a predictive biomarker early on has hampered its chances to enter routine practice. Although recent research suggests benefit in highly selected patient subsets, its potential impact is severely dampened by lack of regulatory body approval and the emergence of competitors for the same niches.

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“…Topical therapy was not included. 17 It is noteworthy that only the Italian panel recommended the use of vitamin K1 cream. In a prospective randomized, double-blinded, placebo-controlled phase 2 trial of 30 patients, menadione exhibited no clinical benefit in terms of reducing the severity of cetuximab skin lesions.…”

mentioning

confidence: 99%

The challenge of managing a cetuximab rash

Pollock¹

2018

JCSO

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Management of Skin Reactions During Cetuximab Treatment in Association With Chemotherapy or Radiotherapy

Abstract: This updated Expert Opinion focuses on how to assess and correctly grade skin reactions according to the latest National Cancer Institute Common Terminology Criteria for Adverse Events and on how to manage these adverse events in clinical practice.

Cited by 29 publications

References 47 publications

Skin toxicity evaluation in patients treated with cetuximab for metastatic colorectal cancer: a new tool for more accurate comprehension of quality of life impacts

Skin toxicity evaluation in patients treated with cetuximab for metastatic colorectal cancer: a new tool for more accurate comprehension of quality of life impacts

Cetuximab for treating non-small cell lung cancer

The challenge of managing a cetuximab rash

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