Third Department of Internal Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany,
J Cancer Res Clin Oncol. 2013 Oct;139(10):1667-72. doi: 10.1007/s00432-013-1483-4. Epub 2013 Aug 7.
Treatment with cetuximab is accompanied by the development of an acneiform follicular skin exanthema in more than 80 % of patients. Severe exanthema (grade III/IV) develops in about 9-19 % of patients with the necessity of cetuximab dose reduction or cessation.
The study presented was a retrospective analysis of 50 gastrointestinal cancer patients treated with cetuximab in combination with either FOLFIRI or FOLFOX. One cohort of 15 patients received an in-house reactive skin protocol upon development of an exanthema. A second cohort of 15 patients received a skin prophylaxis starting with the first dose of cetuximab before clinical signs of toxicity. A third historic group of 20 patients had received no skin prophylaxis or reactive treatment.
19/20 patients of the historic group developed a skin exanthema. Grade III/IV exanthema was observed six times. Forty percent discontinued cetuximab therapy. The average time to exanthema onset was 14.7 days. Applying the reactive skin protocol after the first occurrence of an exanthema, the exanthema was downgraded as follows: No patients developed grade IV° exanthema, and two patients developed a grade II/III exanthema. In the majority of cases, the reactive skin protocol controlled the exanthema (grade 0-I°). No dose reductions in cetuximab were necessary. Applying the prophylactic skin protocol starting at the beginning of cetuximab application was not superior to the reactive skin protocol.
Cetuximab-induced skin exanthema can be coped with a reactive protocol equally effective as compared to a prophylactic skin treatment. A prospective study with higher patient numbers is planned.
在超过 80%的患者中，使用西妥昔单抗治疗会伴随出现痤疮样毛囊性皮肤疹。大约 9-19%的患者会出现严重皮疹（III/IV 级），需要减少或停止使用西妥昔单抗。
本研究对 50 例接受西妥昔单抗联合 FOLFIRI 或 FOLFOX 治疗的胃肠道癌患者进行了回顾性分析。一组 15 例患者在出现皮疹时接受了内部反应性皮肤方案。第二组 15 例患者在首次使用西妥昔单抗前开始皮肤预防，预防从毒性临床症状开始。第三组为 20 例历史对照组患者，他们未接受皮肤预防或反应性治疗。
历史组 19/20 例患者出现皮肤疹。观察到 III/IV 级皮疹 6 次。40%的患者停止了西妥昔单抗治疗。皮疹发作的平均时间为 14.7 天。首次出现皮疹后应用反应性皮肤方案，皮疹如下降级：无一例患者出现 IV°皮疹，有 2 例患者出现 II/III 级皮疹。在大多数情况下，反应性皮肤方案控制了皮疹（0-1°级）。不需要减少西妥昔单抗的剂量。开始应用西妥昔单抗时应用预防性皮肤方案并不优于反应性皮肤方案。
西妥昔单抗诱导的皮肤疹可以通过反应性方案有效控制，与预防性皮肤治疗效果相当。计划进行一项纳入更多患者的前瞻性研究。
