The Epidermal Growth Factor Receptor Inhibitor-Related Skin Toxicity Index (EGFRISTI): A New Tool for Grading and Managing Skin Adverse Reactions to Epidermal Growth Factor Receptor Inhibitors

Abstract

Background: Skin toxicity is frequent and debilitating in oncologic patients treated with epidermal growth factor receptor inhibitors (EGFRIs). Grading and management of skin adverse events (AEs) are poorly standardized. Materials and Methods: We developed a new score (EGFRISTI: Epidermal Growth Factor Receptor Inhibitor-Related Skin Toxicity Index) which is able to quantify and monitor all EGFRI-related dermatologic AEs over time. The utility of this tool was validated in 130 patients treated with 5 different EGFRIs including both monoclonal antibodies and tyrosine kinase inhibitors. Results: The mean baseline EGFRISTI score was 26.9 (range: 6.0-64.5). Mild toxicity was found in 55 patients (42.3%), moderate toxicity in 43 (33.1%), and severe toxicity in 32 patients (24.6%). After the first-line toxicity treatment, an EGFRISTI score reduction of >75% was obtained in 31 patients (34.1%) and one of 50% in 40 patients (43.9%), while an improvement of <50% was observed in the remaining 20 subjects (22.0%). Conclusions: The EGFRISTI is a simple and reliable tool to quantify and express the severity of all clinical signs and symptoms of EGFRI skin toxicity with a single numerical value, to choose the most suitable therapy, and to measure its efficacy.

Histopathologic features of erythematous papulopustular eruption to epidermal growth factor receptor inhibitors in cancer patients

“…Skin biopsies (7 × 4 mm tissue) from involved skin of the upper back were collected under local anesthesia within 21 days from the onset of EPPE and were carried out on a typical and recent lesion of EPPE. The EGFR Inhibitor Skin Toxicity Index (EGFRISTI) was used to grade the EPPE. This scoring tool enables quantification of all EGFR inhibitor‐related dermatologic adverse events, giving each one a numeric value in relation to the severity and extent.…”

Update review of skin adverse events during treatment of lung cancer and colorectal carcinoma with epidermal growth receptor factor inhibitors

“…There have been concerted efforts to develop more precise and clinically relevant tools to quantify and monitor EGFRI-related skin toxicities, including the MASCC EGFRI Skin Toxicity Tool (MESTT) (34) and the EGFRI related Skin Toxicity Index (EGFRISTI) (35). However, the MESTT requires individual pustules to be counted, which is impractical in a busy clinic, and the EGFRISTI is again based on the surface area affected, whose score ranged from 6.0 to 64.5 (36).…”

Relationship between Paronychia and Drug Concentrations of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors

“…The patients received gefitinib (initial dose of 250 mg/day), erlotinib (initial dose of 150 mg/day), and afatinib (initial dose of 50 mg/day). Although EGFR Inhibitor-Related Skin Toxicity Index, which is able to quantify and monitor all EGFRI-related dermatologic adverse events, may be used [9], all toxicities were graded with use of the Common Terminology Criteria for Adverse Events version 4.0 system in this study. Serum and blood samples were collected by finger prick just before the administration of the following EGFR TKI.…”