Leporini Christian, Saullo Francesca, Filippelli Gianfranco, Sorrentino Antonio, Lucia Maria, Perri Gino, Gattuta Gaetana La, Infusino Stefania, Toscano Rosa, Dima Gianluca, Olivito Virginia, Paletta Laura, Bottoni Ugo, De Sarro Giovambattista
Department of Science of Health, School of Medicine, University of Catanzaro, Catanzaro, Italy ; Pharmacovigilance's Centre Calabria Region, University Hospital Mater Domini, Catanzaro, Italy.
Oncology Unit, S. Francesco di Paola Hospital, Paola Province of Cosenza, Italy.
J Pharmacol Pharmacother. 2013 Dec;4(Suppl 1):S78-85. doi: 10.4103/0976-500X.120966.
The epidermal growth factor receptor inhibitors (EGFRIs), cetuximab and panitumumab, represent an effective treatment option for patients affected by metastatic colorectal cancer (mCRC); furthermore, they are relatively devoid of systemic toxicities, which are commonly observed with standard cytotoxic chemotherapy. However, the majority of patients treated with these monoclonal antibodies (mAbs), will experience dermatologic toxicities, most notably the papulopustular skin rash, which can impact quality-of-life and affect adherence to therapy. This paper reviews the most recent practices in the management of skin rash related to anti-epidermal growth factor receptor (EGFR) mAbs, cetuximab and panitumumab, in the treatment of mCRC.
We reviewed relevant literature regarding dermatologic toxicities associated with anti-EGFR mAbs in order to give important indications about prevention and reactive treatment of skin rash.
Two case reports were presented to show how skin rash could hamper mAb EGFRIs use in clinical practice, underscoring the need of implementing a comprehensive management strategy of skin toxicity in order to promote patients' compliance with anti-EGFR therapy and maintain quality-of-life. Based on randomized data, recent guidelines established by the Multinational Association for Supportive Care in Cancer Skin Toxicity Study Group suggest that prophylactic use of oral doxycycline or minocycline reduces the risk and severity of skin rash, improving clinical outcomes.
At the start of treatment with cetuximab and panitumumab, the proper patient education about the skin rash associated with these mAbs and the implementation of a pre-emptive, comprehensive skin toxicity program significantly contribute to improve adherence to therapy, optimize anti-EGFR therapy and maintain quality-of-life.
表皮生长因子受体抑制剂（EGFRIs）西妥昔单抗和帕尼单抗，是转移性结直肠癌（mCRC）患者的一种有效治疗选择；此外，它们相对缺乏全身毒性，而全身毒性在标准细胞毒性化疗中较为常见。然而，大多数接受这些单克隆抗体（mAbs）治疗的患者会出现皮肤毒性，最显著的是丘疹脓疱性皮疹，这可能会影响生活质量并影响治疗依从性。本文综述了在mCRC治疗中，与抗表皮生长因子受体（EGFR）单克隆抗体西妥昔单抗和帕尼单抗相关的皮疹管理的最新实践。
我们回顾了有关抗EGFR单克隆抗体相关皮肤毒性的相关文献，以便给出关于皮疹预防和反应性治疗的重要指征。
两项病例报告展示了皮疹如何在临床实践中阻碍mAb EGFRIs的使用，强调了实施皮肤毒性综合管理策略的必要性，以促进患者对抗EGFR治疗的依从性并维持生活质量。基于随机数据，由多国癌症支持治疗协会皮肤毒性研究组制定的最新指南表明，预防性使用口服多西环素或米诺环素可降低皮疹的风险和严重程度，改善临床结果。
在开始使用西妥昔单抗和帕尼单抗治疗时，对患者进行关于这些单克隆抗体相关皮疹的适当教育，并实施先发制人的综合皮肤毒性计划，对提高治疗依从性、优化抗EGFR治疗和维持生活质量有显著贡献。
