Prevention and management of acneiform rash associated with EGFR inhibitor therapy: A systematic review and meta‐analysis

Abstract

Introduction Epidermal growth factor receptor (EGFR) inhibitors are established therapies for advanced lung, colorectal, and head and neck cancers. They commonly cause acneiform eruptions that affect patient quality of life and may lead to discontinuation of therapy. Methods A systematic review and meta‐analysis was undertaken to assess strategies for the prevention and reactive management of acneiform rash associated with EGFR inhibitor therapy for advanced lung, colorectal, and head and neck cancers. A systematic Medline, Embase, and EBM Reviews database search was conducted on the 2nd of January 2021. The Preferred Reporting Items for Systematic Reviews and Meta‐analyses statement was followed and the studies were critically appraised. Studies were selected if they focused on preventing or treating acneiform eruptions in adults being treated for advanced lung cancer, colorectal cancer, and head and neck cancers with EGFR inhibitors. Results Oral antibiotics had the greatest efficacy in preventing grade 2 or higher acneiform eruptions with a relative risk reduction of 40% (RR = .6, 95% CI .46–.79, p < .01). Other treatment modalities did not have statistically significant results. Topical antibiotics had a total relative risk reduction of 19% (RR = .81, 95% CI .45–1.48, p = .5). Vitamin K1 cream did not reduce the relative risk (RR = 1.08, 95% CI .45–1.48, p = .50). Sunscreen had a total relative risk reduction of 25% (RR = .75, 95% CI .49–1.14, p = .18). Conclusions The results of this meta‐analysis reinforce the fact that oral tetracycline antibiotics are the most efficacious prophylactic option for acneiform eruptions in EGFR inhibitors. They should be offered to suitable patients commencing treatment and used with a general skin‐care routine involving emollients and avoidance of irritants.

Acne-like Eruptions: Disease Features and Differential Diagnosis

“…The rash is more frequently reported with EGFR monoclonal antibody drugs. It usually emerges following the initial treatment cycle and reaches its peak incidence between three to four weeks of therapy [113,114]. The management of EGFRI-induced lesions depends on the severity of the condition, which is evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) grading system.…”

Differences in Management Between Dermatologists and Oncologists for Acneiform Eruptions in Patients on Monoclonal Antibody Epidermal Growth Factor Receptor Inhibitors

“…2 Ultimately, the eruption may lead to clinical decisions to hold or discontinue lifesaving cancer treatment. 2 We present a retrospective analysis of patients with metastatic head and neck and colorectal cancer treated with firstline monoclonal antibody EGFR-i (panitumumab and cetuximab) at our institution between January 2017 and December 2021 (Table 1). Of the 66 patients who started treatment, 42 (63.6%) developed an acneiform eruption: 21 (50.0%) were mild [common terminology criteria for adverse events (CTCAE) Grade 1], 8 (19.0%) were moderate (CTCAE Grade 2), and 5 (11.9%) were severe (CTCAE Grade 3 or above).…”

“…1 Acneiform eruptions are their most common skin toxicity, with a 50% to 100% incidence rate. 2 They arise within 1 to 3 weeks of EGFR inhibitor (EGFR-i) initiation, typically on the scalp, face, back, and chest, with a peak in intensity at 3 to 5 weeks. 2 Ultimately, the eruption may lead to clinical decisions to hold or discontinue lifesaving cancer treatment.…”

“…2 They arise within 1 to 3 weeks of EGFR inhibitor (EGFR-i) initiation, typically on the scalp, face, back, and chest, with a peak in intensity at 3 to 5 weeks. 2 Ultimately, the eruption may lead to clinical decisions to hold or discontinue lifesaving cancer treatment. 2 We present a retrospective analysis of patients with metastatic head and neck and colorectal cancer treated with firstline monoclonal antibody EGFR-i (panitumumab and cetuximab) at our institution between January 2017 and December 2021 (Table 1).…”

“…2 Ultimately, the eruption may lead to clinical decisions to hold or discontinue lifesaving cancer treatment. 2…”