Medical Oncology Unit, ASL Frosinone, Frosinone, Italy.
Support Care Cancer. 2013 Jun;21(6):1691-5. doi: 10.1007/s00520-012-1715-1. Epub 2013 Jan 13.
Anti-epidermal growth factor receptor (EGFR) target therapies like erlotinib for metastatic lung cancer and cetuximab or panitumumab for metastatic colorectal cancer (mCRC) cause skin reaction that seems to be related to treatment efficacy. Skin toxicity evaluation protocol with panitumumab study has shown that preemptive treatment reduces the incidence of ≥Grade 2 (G2) skin toxicity in mCRC treated with panitumumab. Aim of this study is to evaluate if preemptive skin toxicity treatment with different drugs has good efficacy in patients receiving anti-EGFR therapies, such as cetuximab, panitumumab, and erlotinib, for mCRC and metastatic lung cancer.
Treatment included skin moisturizers with sunscreen and lymecycline 300 mg/daily. Primary objective is to reduce the incidence of ≥G2 skin toxicity during the first 3 months of therapy. Toxicities are reported with confidence interval at 95%. Quality of life was assessed with Dermatology Life Quality Index every 2 weeks and evaluated with repeated measure ANOVA.
Fifty-one patients with mCRC (60.8%) and metastatic lung cancer (39.2%) were enrolled. Anticancer drugs were erlotinib/cetuximab/panitumumab 20:30:1. At 3-month evaluation, 27.4% patients had =G2 skin toxicity. Skin toxicity was not related with age (p = 0.67), sex (p = 0.65), previous chemotherapy regimens (p = 0.41), and current anti-EGFR treatment (p = 0.22). No gastrointestinal or hematological toxicities related to lymecycline were observed. Only six patients required further drugs. Quality of life analysis did not show a significant difference from the beginning and the end of treatment.
Data show efficacy of preemptive treatment with a well-tolerated profile. A reduction of severe skin toxicities is shown with an increase of grade 1 toxicities, not leading to anti-EGFR dose reduction and with better quality of life for patients.
针对转移性肺癌的表皮生长因子受体 (EGFR) 靶向治疗药物，如厄洛替尼，以及针对转移性结直肠癌 (mCRC) 的西妥昔单抗或帕尼单抗，会引起皮肤反应，这种反应似乎与治疗效果有关。一项针对帕尼单抗的皮肤毒性评估方案显示，对于接受帕尼单抗治疗的 mCRC 患者，预先进行皮肤毒性治疗可降低 ≥2 级（G2）皮肤毒性的发生率。本研究旨在评估针对 mCRC 和转移性肺癌患者接受 EGFR 靶向治疗药物（如西妥昔单抗、帕尼单抗和厄洛替尼）时，使用不同药物进行预先皮肤毒性治疗的疗效。
治疗方案包括使用含有防晒霜的皮肤保湿剂和盐酸米诺环素，每日 300 毫克。主要目标是降低治疗开始后 3 个月内 ≥G2 皮肤毒性的发生率。采用置信区间在 95%的方法报告毒性。每两周使用皮肤病生活质量指数评估生活质量，并采用重复测量方差分析进行评估。
共纳入 51 例 mCRC（60.8%）和转移性肺癌（39.2%）患者。抗癌药物为厄洛替尼/西妥昔单抗/帕尼单抗，比例为 20:30:1。在 3 个月评估时，27.4%的患者出现 G2 级皮肤毒性。皮肤毒性与年龄（p=0.67）、性别（p=0.65）、先前的化疗方案（p=0.41）和当前的 EGFR 治疗（p=0.22）无关。未观察到与盐酸米诺环素相关的胃肠道或血液学毒性。仅 6 例患者需要进一步用药。治疗开始和结束时的生活质量分析无显著差异。
数据显示预先进行皮肤毒性治疗具有良好的疗效，且耐受性良好。通过增加 1 级毒性，降低了严重皮肤毒性的发生率，没有导致 EGFR 靶向治疗药物剂量减少，并改善了患者的生活质量。
