Toxicity profile of epidermal growth factor receptor tyrosine kinase inhibitors for patients with lung cancer: A systematic review and network meta-analysis

Zhao, Yi; Cheng, Bo; Chen, Zisheng; Li, Jianfu; Liang, Hengrui; Chen, Ying; Zhu, Feng; Li, Caichen; Xu, Ke; Xiong, Shan; Lu, Weicong; Chen, Zhuxing; Zhong, Ran; Xie, Zhanhong; Li, Jun; Liang, Wenhua; He, Jianxing

doi:10.1016/j.critrevonc.2021.103305

Cited by 37 publications

(18 citation statements)

References 88 publications

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“…112 Studies comparing EGFR inhibition to standard chemotherapy in lung cancer have consistently shown higher levels of acneiform rash (26%-84% vs 6%-19%) and other dermatologic toxicities (see Table 1), but less alopecia (0%-3% vs 11%-35%) and nondermatologic symptoms. [113][114][115][116][117][118][119][120][121] Second-generation inhibitors (dacomitinib and afatinib) have the highest levels of dermatologic (and overall systemic) toxicities, followed by firstgeneration inhibitors (erlotinib > gefitinib) and third-generation osimertinib (which has the most hematologic toxicities). 112,121 The first-generation inhibitor icotinib has the best cutaneous safety profile, including 15% to 40% rash.…”

Section: Egfr-pi3k-akt Inhibitorsmentioning

confidence: 99%

Diverse landscape of dermatologic toxicities from small‐molecule inhibitor cancer therapy

et al. 2021

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Background: Advances in molecular biology and genetics have contributed to breakthrough treatments directed at specific pathways associated with the development of cancer. Small-molecule inhibitors (Nibs) aimed at a variety of cellular pathways have been efficacious; however, they are associated with significant dermatologic toxicities. Methods: We conducted a comprehensive review of dermatologic toxicities associated with Nibs categorized into the following five groups: (a) mitogen-activated protein kinase; (b) growth factor/multi-tyrosine kinase; (c) cell division/DNA repair; (d) signaling associated with myeloproliferative neoplasms; and (e) other signaling pathways. Prospective phase I, II, or III clinical trials, retrospective literature reviews, systematic reviews/meta-analyses, and case reviews/reports were included for analysis.Results: Dermatologic toxicities reviewed were associated with every class of Nibs and ranged from mild to severe or life-threatening adverse skin reactions.Inflammatory reactions manifesting as maculopapular, papulopustular/acneiform, and eczematous lesions were frequent types of dermatologic toxicities seen with Nibs.Squamous cell carcinoma with keratoacanthoma-like features was associated with a subset of Nibs. Substantial overlap in dermatologic toxicities was found between Nibs.Conclusions: Dermatologic toxicities from Nibs are diverse and may overlap between classes of Nibs. Recognition of the various types of toxicities from Nibs is critical for patient care in the era of "oncodermatology/dermatopathology."

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Section: Egfr-pi3k-akt Inhibitorsmentioning

confidence: 99%

Diverse landscape of dermatologic toxicities from small‐molecule inhibitor cancer therapy

et al. 2021

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“…The rate of pathological complete response (pCR) after neoadjuvant use of EGFR-TKIs is low (0-12%) [37][38][39]. Major pathological response (MPR) is noted in 8-24% of patients [38,43,47]. The results of MPR and pCR rates are worse in the case of EGFR-TKIs than with immune checkpoint inhibitors reported recently [72].…”

Section: Neoadjuvant Egfr-tkis In Early Nsclcmentioning

confidence: 99%

“…The most common adverse events of administration of EGFR-TKIs in advanced NSCLC are skin toxicity, gastrointestinal toxicity, pulmonary toxicity, hepatic toxicity, and ocular toxicity [26,[47][48][49]. EGFR-TKIs are generally well tolerated.…”

Section: Typical Complications Of Egfr-tkismentioning

confidence: 99%

“…EGFR-TKIs are generally well tolerated. However, administration of the drugs may be related to a few toxicities leading to treatment discontinuation and/or dose reduction due to poor patients' adherence [47,48]. Grade 3/4 toxicities according to the Common Toxicity Criteria for Adverse Events (CTCAE) are reported to occur in 29% of patients treated with gefitinib, 54% of patients treated with erlotinib, and 42% of patients treated with afatinib.…”

Section: Typical Complications Of Egfr-tkismentioning

confidence: 99%

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Safety of Surgery after Neoadjuvant Targeted Therapies in Non-Small Cell Lung Cancer: A Narrative Review

Marjański

Dziedzic

Kowalczyk

et al. 2021

IJMS

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New drugs, including immune checkpoint inhibitors and targeted therapy, have changed the prognosis in a subset of patients with advanced lung cancer, and are now actively investigated in a number of trials with neoadjuvant and adjuvant regimens. However, no phase III randomized studies were published yet. The current narrative review proves that targeted therapies are safe in neoadjuvant approach. Unsurprisingly, administration of therapy is related to an acceptable toxicity profile. Severe adverse events’ rate that rarely compromises outcomes of patients with advanced lung cancer is not that commonly accepted in early lung cancer as it may lead to missing the chance of curative surgery. Among those complications, the most important factors that may limit the use of targeted therapies are severe respiratory adverse events precluding the resection occurring after treatment with some anaplastic lymphoma kinase and rarely after epidermal growth factor receptor tyrosine kinase inhibitors. At this point, in the presented literature assessing the feasibility of neoadjuvant therapies with anaplastic lymphoma kinase and epidermal growth factor receptor tyrosine kinase inhibitors, we did not find any unexpected intraoperative events that would be of special interest to a thoracic surgeon. Moreover, the postoperative course was associated with typical rate of complications.

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“…Although currently not fully elucidated, discrepancies in pneumonitis rates among studies could relate to the setting (e.g., concurrent versus maintenance) and duration of TKI use, including choice of individual TKI. 14 Without a doubt, detection and targeting of EGFR-m have transformed the standard of care in the metastatic setting. Nevertheless, available data including WJOG6911L as yet do not as strongly support superior efficacy or comparable safety of tested TKI regimens in LA-NSCLC.…”

mentioning

confidence: 99%

Tyrosine Kinase Inhibitor Therapy in Unresectable Locally Advanced NSCLC: Keep Holding Our Breaths or Time to Take a Breather?

Mesci

Tsakiridis

Swaminath

2021

Journal of Thoracic Oncology

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Toxicity profile of epidermal growth factor receptor tyrosine kinase inhibitors for patients with lung cancer: A systematic review and network meta-analysis

Cited by 37 publications

References 88 publications

Diverse landscape of dermatologic toxicities from small‐molecule inhibitor cancer therapy

Diverse landscape of dermatologic toxicities from small‐molecule inhibitor cancer therapy

Safety of Surgery after Neoadjuvant Targeted Therapies in Non-Small Cell Lung Cancer: A Narrative Review

Tyrosine Kinase Inhibitor Therapy in Unresectable Locally Advanced NSCLC: Keep Holding Our Breaths or Time to Take a Breather?

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