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Description and management of cutaneous side effects during cetuximab or erlotinib treatments: A prospective study of 30 patients

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Background

Drugs such as cetuximab or erlotinib, which inhibit the epidermal growth factor receptor, are increasingly being used in treatment of solid tumors. This has led to the appearance of new secondary effects.

Objective

We sought to describe the cutaneous side effects and their management in patients with cancer treated with cetuximab or erlotinib.

Methods

We clinically examined 30 patients determining type, frequency, treatment, and evolution of side effects.

Results

Most patients presented with a cutaneous reaction consisting of a follicular eruption, typically appearing in seborrheic areas within the first 15 days of treatment. Painful fissures in palms and soles and paronychia were the second most common cutaneous toxicities. We also noticed an alteration in hair growth at several months' follow-up. As these secondary effects responded well to treatment, few patients discontinued the antineoplastic therapy because of cutaneous toxicity.

Limitations

This was a prospective but uncontrolled study.

Conclusion

Although these new targeted therapies have low systemic toxicity because of their high specificity, cutaneous side effects are common and may be serious.

Section snippets

Methods

Between March 2004 and July 2005, 30 patients (20 men and 10 women) with a mean age of 64.7 years (range: 37-85 years) who were under treatment with EGFR inhibitors were studied by means of dermatologic evaluation and photography monthly. We included all patients in treatment with cetuximab in our hospital (17) and only the patients who presented cutaneous adverse effects in treatment with erlotinib (13 of 28). All patients were in stage 4 of their disease (colorectal or lung cancer). Patients'

Results

In the group treated with cetuximab, 14 of 17 patients developed an acneiform eruption that was characterized by pruritic follicular pustular and papular erythematous lesions. No comedos or cysts were present. This eruption was predominantly distributed in the seborrheic areas, mainly on the face (nose, cheeks, nasolabial folds, chin, forehead, and perioral distribution) (Fig 1). Other main locations included shoulders and trunk, particularly the V-shaped area of the chest (Fig 2) and upper

Discussion

Cetuximab is a monoclonal antibody to the EGFR approved for irinotecan-resistant metastatic colorectal cancer, and erlotinib is approved in the United States for chemotherapy-resistant non-small cell lung cancer. In addition, these and other EGFR-targeting therapies are under investigation for broader indications and for use in other cancers, notably those of the head and neck, pancreas, lung, and ovaries. These drugs block the EGFR and, therefore, inhibit the proliferation of a variety of

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    Funding sources: None.

    Conflicts of interest: None identified.

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