New agents, new rashes: An update on skin complications from cancer chemotherapy

Abstract

Several new drugs have emerged as effective antineoplastic agents in the past 5 years. Many of these drugs cause rashes. For example, rash is one of the two most frequent adverse events that occur in cancer patients prescribed epidermal growth factor receptor inhibitors. This review discusses rash in the context of epidermal growth factor receptor inhibitors and in the context of a few other recently approved cancer drugs. It also embarks on a brief discussion of issues that investigators must face when designing clinical trials aimed at rash palliation.

Rash from EGFR inhibitors: Opportunities and challenges for palliation

“…Some aspects of its distribution are also similar to that observed with acne, with involvement of the face, trunk, and upper extremities [ 5 ]. However, Lacouture [ 7•• ] has characterized various other more subtle clinical aspects of this rash that, at times, put its appearance at odds with typical acne.…”

“…Rash continues to be a common and challenging side effect and occurs in more than 70% of patients [ 5 ]. Indeed, the frequent and problematic nature of these rashes has spawned a multidisciplinary approach at some medical centers in an effort to control this side effect [ 6 ].…”

Search for Evidence-Based Approaches for the Prevention and Palliation of Hand–Foot Skin Reaction (HFSR) Caused by the Multikinase Inhibitors (MKIs)

“…Specifically, research is needed on: (a) appropriate patient education on prophylaxis for HFSR and its effects on patient outcomes; (b) how often the patient should be seen by an oncologist or dermatologist after beginning treatment with MKIs; (c) how to accurately diagnose HFSR in its mild forms and recognize subsequent dermatologic complications; (d) how to effectively treat and remove the calluses on hands and feet without leading to increased HFSR damage and symptom burden; (e) providing guidance to both patients and providers on the best types of gel inserts, cushions, and soft footwear; (f) identifying the treatment strategies that are most effective at each grade of toxicity or severity; and (g) testing the effectiveness of specific emollients and keratolytic creams for preemptive or reactive treatment of MKI-associated HFSR. Efficacy studies on novel mechanism-based prophylactic or palliative therapy are needed to provide the data that may ultimately lead to the development of better tolerance of novel antineoplastic or targeted therapies with reduced dermatologic side effects [41]. A major pitfall of conducting such trials is the risk of ascribing an improvement to the palliative agent, when that improvement may represent the natural history of the dermatologic reaction or poor compliance with the inciting agent (MKI) [41].…”

“…Efficacy studies on novel mechanism-based prophylactic or palliative therapy are needed to provide the data that may ultimately lead to the development of better tolerance of novel antineoplastic or targeted therapies with reduced dermatologic side effects [41]. A major pitfall of conducting such trials is the risk of ascribing an improvement to the palliative agent, when that improvement may represent the natural history of the dermatologic reaction or poor compliance with the inciting agent (MKI) [41]. Because dose reductions can postpone or undermine optimal anticancer treatment efficacy, the prevention and minimization of dermatologic adverse events through prompt recognition and management is an important goal.…”

“…In this regard, the dermatology literature shows that several questionnaires are available for patients to complete on a regular basis and thus provide information about their condition to aid investigators in understanding whether the dermatologic symptoms are worsening or improving and their impact on the patient's QoL [42,43]; however, none of the available measurement tools were developed to specifically assess HFSR. Detailed questionnaires for patient completion should be used in conjunction with accepted criteria, such as the NCI-CTCAE v3.0 [13,41].…”