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ways to possibly prevent/mitigate skin problems with lapatinib
the following study was done with a monoclonal antibody (an infused monoclonal antibody drug --like herceptin) rather than a tyrosine kinase inhibitor (oral drug-- like lapatinib) and one that is only an EGFR inhibitor rather than lapatinib which is both an EGFR inhibitor and a her2 inhibitor, but as the skin problems of lapatinib are felt to stem from its EGFR inhibition...perhaps the findings might apply to lapatinib too (sorry for the long sentence!):
SAN FRANCISCO, Jan. 21 -- In patients with metastatic colorectal cancer, pre-emptive skin treatment reduced the frequency and severity of toxicity from an epidermal growth factor receptor inhibitor, data reported here showed.
The occurrence of skin toxicity was reduced by half in patients who received prophylactic skin therapy before starting chemotherapy containing panitumumab (Vectibix), Edith Mitchell, M.D., of Thomas Jefferson University in Philadelphia, reported at the Gastrointestinal Cancers Symposium.
The regimen led to more than a three-fold reduction in the rate of severe skin toxicity.
"Panitumumab and other EGFR inhibitors are now key components to the treatment strategies for metastatic colorectal cancer," said Dr. Mitchell. "The majority of patients who receive these agents suffer from skin toxicities, and for some patients, the treatment must be interrupted or discontinued. If we can prevent or minimize these toxicities, it would be a significant advance in patient care." Action Points
Explain to patients that a preventive skin treatment reduced the adverse skin effects of therapy for metastatic colorectal cancer.
Patients randomized to pre-emptive skin therapy began treatment 24 hours before the first scheduled dose of panitumumab and continued for six weeks. The remaining patients received reactive therapy for specific types of skin toxicity as the manifestations occurred.
The pre-emptive regimen consisted of moisturizers, PABA-free sunscreen rated SPF≥15, topical steroid cream, and doxycycline 100 mg twice daily.
The primary endpoint was the incidence of specific grade 2 or more skin toxicities during the six weeks of treatment.
At the end of the study, patients randomized to pre-emptive skin therapy had a 29% incidence of protocol-specified grade 2 or more skin toxicities compared with 62% among patients given reactive skin treatment.
Stratification of skin toxicities by severity revealed a 23% occurrence of grade 2 events in patients randomized to pre-emptive treatment versus 40% in the reactive-therapy group. Grade 3 skin toxicity occurred in 6% of patients in the pre-emptive therapy group and 21% of those randomized to reactive therapy.
The overall incidence of grade 3+ adverse events was 60% in patients given pre-emptive therapy and 81% in the reactive-therapy group.
The median time to grade 2 or more skin toxicity was 2.7 weeks with reactive therapy but was not reached in the pre-emptive therapy group.
the following caveat was added:
Note that this study was published as an abstract and presented as a poster at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Treatment of skin toxicity usually is symptom driven, she continued. Prevention would be preferable, and toward that end, investigators performed a randomized clinical study of 95 patients receiving panitumumab-containing therapy.
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