Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.
Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy,
Dermatology. 2021;237(6):929-933. doi: 10.1159/000513233. Epub 2021 Jan 28.
Epidermal growth factor receptor (EGFR) inhibitors are routinely used in advanced non-small-cell lung cancer (NSCLC) harboring EGFR mutations. However, their use is associated with gastrointestinal and cutaneous toxicities, including acneiform eruptions, pruritus, xerosis, nail and hair changes. Aside from reducing patients' quality of life, such cutaneous reactions have a considerable impact on the oncologic treatment given that dose reduction or even drug discontinuation may be necessary, especially for the severe forms.
To assess the incidence, impact on treatment and management of EGFR inhibitor-related cutaneous reactions in patients with NSCLC.
We conducted a prospective observational study on 87 consecutive patients with advanced NSCLC treated with EGFR-tyrosine kinase inhibitors from January to December 2019. Patients who developed mucocutaneous reactions were evaluated and treated by both oncologists and dermatologists, and underwent dermatologic follow-up until resolution of the cutaneous reaction. Demographic and clinical data were collected for each patient, and the severity of the cutaneous reaction was graded using the Common Terminology Criteria for Adverse Events.
Seventy-one patients (81.6%) developed cutaneous reactions. The number of cutaneous reactions per patient was 1 in 37%, 2 in 41% and 3 or more in 22%. The most common cutaneous reactions included acneiform eruptions (56.3%), xerosis ± asteatotic eczema (48.3%), nail changes (39.1%), mucositis (29.9%), pruritus (24.1%) and hair changes (12.6%). Afatinib was associated with a higher rate of nail changes and mucositis (p < 0.01 and p < 0.005, respectively) compared to other agents, while no patient-related predictive factors were identified. Dose reduction was performed in 18% of patients. Multidisciplinary management involving dermatologists allowed to resume the drug in all patients who had discontinued it due to the cutaneous reactions.
A multidisciplinary approach to EGFR inhibitor-related cutaneous reactions is advantageous and can reduce the need to discontinue oncologic treatment.
表皮生长因子受体（EGFR）抑制剂常用于治疗携带 EGFR 突变的晚期非小细胞肺癌（NSCLC）。然而，其使用与胃肠道和皮肤毒性相关，包括痤疮样皮疹、瘙痒、皮肤干燥、指甲和毛发改变。除了降低患者的生活质量外，这些皮肤反应还会对肿瘤治疗产生重大影响，因为可能需要减少剂量甚至停药，尤其是对于严重的皮肤反应。
评估 EGFR 抑制剂相关皮肤反应在 NSCLC 患者中的发生率、对治疗的影响和管理方法。
我们对 2019 年 1 月至 12 月期间接受 EGFR 酪氨酸激酶抑制剂治疗的 87 例晚期 NSCLC 连续患者进行了一项前瞻性观察性研究。评估并治疗发生黏膜皮肤反应的患者，由肿瘤学家和皮肤科医生共同进行，并对患者进行皮肤科随访，直至皮肤反应消退。收集每位患者的人口统计学和临床数据，并使用不良事件通用术语标准对皮肤反应的严重程度进行分级。
71 例患者（81.6%）出现皮肤反应。每位患者的皮肤反应数量为 1 次占 37%，2 次占 41%，3 次或以上占 22%。最常见的皮肤反应包括痤疮样皮疹（56.3%）、皮肤干燥伴或不伴角化过度性湿疹（48.3%）、指甲改变（39.1%）、黏膜炎（29.9%）、瘙痒（24.1%）和毛发改变（12.6%）。与其他药物相比，阿法替尼与更高的指甲改变和黏膜炎发生率相关（p<0.01 和 p<0.005），但未发现与患者相关的预测因素。18%的患者需要减少剂量。涉及皮肤科医生的多学科管理使得所有因皮肤反应而停药的患者都能够恢复药物治疗。
多学科方法治疗 EGFR 抑制剂相关皮肤反应是有利的，可以减少停止肿瘤治疗的需要。
Zotero 插件