Elsevier

Journal of Thoracic Oncology

Volume 5, Issue 10, October 2010, Pages 1662-1663
Journal of Thoracic Oncology

Brief Reports
Isotretinoin Plus Clindamycin Seem Highly Effective Against Severe Erlotinib-Induced Skin Rash in Advanced Non-small Cell Lung Cancer

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Introduction:

Erlotinib is useful in advanced non-small cell lung cancer although compliance and efficacy are diminished by skin rash in a high proportion of patients, often necessitating dose reduction or drug withdrawal. No effective treatment for the rash is available.

Methods:

We carried out a preliminary investigation on isotretinoin and clindamycin. Among 56 advanced lung cancer patients treated with erlotinib, 31 (53%) developed rash. Seven (35%) of the 20 G2/G3 cases agreed to treatment with clindamycin (450 mg/d, days 1–10; 300 mg/d, days 11–20) plus isotretinoin (20 mg/d, days 11–20) after being informed of the experimental nature of the combination.

Results:

In 6 of 7 (86%) patients, the rash resolved (G1/G0) without dose reduction; in the other patient (G3), the erlotinib dose also had to be reduced. Median time to resolution was 14 days (range 7–20 days). No rash-treatment adverse events occurred during 20 days of administration.

Conclusions:

Isotretinoin plus clindamycin promises to be the first effective treatment for erlotinib rash and is being tested further.

Key Words:

Isotretinoin
Clindamycin
Erlotinib
Skin rash
Non-small cell lung cancer

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Disclosure: The authors declare no conflicts of interest.