Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Rockefeller Outpatient Pavilion, Suite 228, 160 E 53rd St., New York, NY, 10022, USA.
Curr Treat Options Oncol. 2013 Sep;14(3):389-404. doi: 10.1007/s11864-013-0254-4.
Rapid advances in drug discovery and the regulatory approval of a number of novel anticancer agents during the past decade pose unique challenges to the oncology community. While the benefits of such therapies receive most attention, adverse events (AEs), especially those pertaining to subspecialties (e.g., dermatology), often are underemphasized. To ensure best clinical outcomes, it would be important to bridge the gap between approval of a new drug and devising effective management strategies for the AEs. With the incorporation of targeted therapies to the treatment paradigm of gastrointestinal malignancies, there has been a significant rise in dermatologic AEs among those treated. In addition to significantly affecting patients' quality of life, these AEs represent a growing problem and are relatively unfamiliar to many oncologists. The issue is further complicated by the lack of evidence-based management guidelines for such AEs in the oncology setting, the "generalizing" of terminology (e.g., rash) for some AEs, as well as an insufficient number of oncodermatologists for assistance with their management. It is important for the oncologist to gain familiarity with the most common, manageable and predictable AEs. Their identification is usually based on medical history, clinical features, and full-body skin examination (FBSE) and at times by obtaining a skin biopsy to aid in diagnosis. Although efforts are underway, presently, there is a paucity of biomarkers (e.g., serologic, genetic) to predict dermatologic AEs. Management often requires a multifaceted approach and includes topical, systemic, surgical, and physical (e.g., cryotherapy) modalities of treatment. Unfortunately, very few clinical trials have focused on this aspect of supportive care; therefore, most data on management derives from anecdotal data. Patients should be encouraged to actively report skin problems, while oncologists should play a vital role in addressing these AEs in their patients. Lastly, further research at the molecular and cellular level may assist in the elucidation of the mechanisms underlying these AEs and their clinical correlates, paving way for the design of effective therapies in this subset of patients.
在过去十年中，药物发现的快速进展和许多新型抗癌药物的监管批准给肿瘤学界带来了独特的挑战。虽然这些疗法的益处受到了大多数关注，但不良反应 (AE)，特别是涉及亚专业的不良反应（例如皮肤病学），往往被低估了。为了确保最佳的临床结果，在新药批准和制定针对不良反应的有效管理策略之间架起桥梁非常重要。随着靶向治疗被纳入胃肠道恶性肿瘤的治疗模式，接受治疗的患者中皮肤病学不良反应显著增加。除了严重影响患者的生活质量外，这些不良反应还代表着一个日益严重的问题，并且许多肿瘤学家对此并不熟悉。由于缺乏针对肿瘤学中此类不良反应的循证管理指南，一些不良反应的术语（例如皮疹）被“泛化”，以及帮助管理这些不良反应的肿瘤皮肤科医生数量不足，问题变得更加复杂。肿瘤学家熟悉最常见、可管理和可预测的不良反应非常重要。它们的识别通常基于病史、临床特征和全身皮肤检查 (FBSE)，有时还需要进行皮肤活检以协助诊断。尽管正在努力，但目前，预测皮肤病学不良反应的生物标志物（例如血清学、遗传学）很少。管理通常需要多方面的方法，包括局部、全身、手术和物理（例如冷冻疗法）治疗方式。不幸的是，很少有临床试验专注于这方面的支持性护理；因此，大多数管理数据都来自轶事数据。应鼓励患者积极报告皮肤问题，而肿瘤学家应在解决患者的这些不良反应方面发挥重要作用。最后，在分子和细胞水平上的进一步研究可能有助于阐明这些不良反应及其临床相关性的机制，为这部分患者的有效治疗方法设计铺平道路。
