Westmead Hospital Dermatology Department, Sydney, New South Wales, Australia.
Department of Medical Oncology, Northern Clinical School, University of Sydney, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Asia Pac J Clin Oncol. 2022 Dec;18(6):526-539. doi: 10.1111/ajco.13740. Epub 2022 Mar 29.
Epidermal growth factor receptor (EGFR) inhibitors are established therapies for advanced lung, colorectal, and head and neck cancers. They commonly cause acneiform eruptions that affect patient quality of life and may lead to discontinuation of therapy.
A systematic review and meta-analysis was undertaken to assess strategies for the prevention and reactive management of acneiform rash associated with EGFR inhibitor therapy for advanced lung, colorectal, and head and neck cancers. A systematic Medline, Embase, and EBM Reviews database search was conducted on the 2nd of January 2021. The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed and the studies were critically appraised. Studies were selected if they focused on preventing or treating acneiform eruptions in adults being treated for advanced lung cancer, colorectal cancer, and head and neck cancers with EGFR inhibitors.
Oral antibiotics had the greatest efficacy in preventing grade 2 or higher acneiform eruptions with a relative risk reduction of 40% (RR = .6, 95% CI .46-.79, p < .01). Other treatment modalities did not have statistically significant results. Topical antibiotics had a total relative risk reduction of 19% (RR = .81, 95% CI .45-1.48, p = .5). Vitamin K1 cream did not reduce the relative risk (RR = 1.08, 95% CI .45-1.48, p = .50). Sunscreen had a total relative risk reduction of 25% (RR = .75, 95% CI .49-1.14, p = .18).
The results of this meta-analysis reinforce the fact that oral tetracycline antibiotics are the most efficacious prophylactic option for acneiform eruptions in EGFR inhibitors. They should be offered to suitable patients commencing treatment and used with a general skin-care routine involving emollients and avoidance of irritants.
表皮生长因子受体（EGFR）抑制剂是治疗晚期肺癌、结直肠癌和头颈部癌症的标准疗法。它们通常会引起痤疮样皮疹，影响患者的生活质量，并可能导致治疗中断。
系统评价和荟萃分析评估了预防和治疗 EGFR 抑制剂治疗晚期肺癌、结直肠癌和头颈部癌症相关痤疮样皮疹的策略。于 2021 年 1 月 2 日在 Medline、Embase 和 EBM Reviews 数据库中进行了系统检索。遵循系统评价和荟萃分析报告的首选项目，并对研究进行了批判性评估。如果研究侧重于预防或治疗接受 EGFR 抑制剂治疗的晚期肺癌、结直肠癌和头颈部癌症的成人中痤疮样皮疹，则选择这些研究。
口服抗生素在预防 2 级或更高级别痤疮样皮疹方面最有效，相对风险降低 40%（RR=0.6，95%CI 0.46-0.79，p<0.01）。其他治疗方法没有统计学意义。局部抗生素的总相对风险降低了 19%（RR=0.81，95%CI 0.45-1.48，p=0.5）。维生素 K1 霜并未降低相对风险（RR=1.08，95%CI 0.45-1.48，p=0.50）。防晒霜的总相对风险降低了 25%（RR=0.75，95%CI 0.49-1.14，p=0.18）。
这项荟萃分析的结果证实，口服四环素抗生素是 EGFR 抑制剂治疗痤疮样皮疹最有效的预防选择。应向开始治疗的合适患者提供，并与包含保湿剂和避免刺激物的一般皮肤护理常规一起使用。
