Jaka A, Gutiérrez-Rivera A, López-Pestaña A, del Alcázar E, Zubizarreta J, Vildosola S, Arregui M A, Sarasqueta C, Lobo C, Tuneu A
Servicio de Dermatología. Hospital Universitario Donostia, San Sebastián, España.
Laboratorio de Ingeniería tisular, Instituto Biodonostia, Hospital Universitario Donostia, San Sebastián, España.
Actas Dermosifiliogr. 2015 Jul-Aug;106(6):483-92. doi: 10.1016/j.ad.2015.01.006. Epub 2015 Mar 19.
Cetuximab and panitumumab are monoclonal antibodies that target the epidermal growth factor receptor (EGFR) in the treatment of metastatic colorectal cancer. Most patients develop a papulopustular rash, which may predict tumor response. We studied whether the other adverse cutaneous effects associated with these monoclonal antibodies are also clinical predictors of response. We also reviewed publications describing approaches to treating the papulopustular rash since no evidence-based guidelines have yet been published.
We performed a retrospective study of 116 patients with metastatic colorectal cancer receiving anti-EGRF therapy with cetuximab or panitumumab at Hospital Universitario Donostia.
In total, 81.9% of the patients developed a papulopustular rash. Patients who received the most cycles of treatment with the EGFR inhibitor were at the highest risk of developing the rash, and these patients also had the most severe rash reactions (P=.03). All of the patients who exhibited a complete tumor response had the rash, and the incidence of rash was lower in patients with poor tumor response (P=.03). We also observed an association between tumor response and xerosis (53.4% of the patients who developed xerosis also exhibited tumor response, P=.002). The papulopustular rash was managed according to an algorithm developed by our department.
Severe papulopustular rash and xerosis may be clinical predictors of good response to anti-EGFR therapy. Patients who develop a papulopustular rash should be treated promptly because suboptimal treatment of this and other adverse effects can lead to delays in taking the prescribed anti-EGFR dose or to interruption of therapy.
西妥昔单抗和帕尼单抗是用于治疗转移性结直肠癌的靶向表皮生长因子受体（EGFR）的单克隆抗体。大多数患者会出现丘疹脓疱性皮疹，这可能预示肿瘤反应。我们研究了与这些单克隆抗体相关的其他皮肤不良反应是否也是反应的临床预测指标。由于尚未发布基于证据的指南，我们还回顾了描述丘疹脓疱性皮疹治疗方法的文献。
我们对在多诺斯提亚大学医院接受西妥昔单抗或帕尼单抗抗EGFR治疗的116例转移性结直肠癌患者进行了回顾性研究。
总共81.9%的患者出现了丘疹脓疱性皮疹。接受EGFR抑制剂治疗周期最多的患者出现皮疹的风险最高，且这些患者的皮疹反应也最严重（P = 0.03）。所有出现完全肿瘤缓解的患者都有皮疹，而肿瘤反应较差的患者皮疹发生率较低（P = 0.03）。我们还观察到肿瘤反应与皮肤干燥之间存在关联（出现皮肤干燥的患者中有53.4%也出现了肿瘤反应，P = 0.002）。丘疹脓疱性皮疹按照我们科室制定的算法进行处理。
严重的丘疹脓疱性皮疹和皮肤干燥可能是抗EGFR治疗反应良好的临床预测指标。出现丘疹脓疱性皮疹的患者应及时治疗，因为对这种及其他不良反应治疗不当会导致延迟服用规定的抗EGFR剂量或中断治疗。
