preventive program vs EGFR inhibitor type rash seems promising

[Lani]

? may work vs tykerb indiced rash, too?

a preventive skin care regimen reduced skin toxicity by 50% in patients with colorectal cancer treated with a type of therapy known as an EGFR inhibitor

ORLANDO, May 31 -- Prophylactic treatment reduced skin toxicity by 50% in patients with colorectal cancer treated with the epidermal growth factor receptor (EGFR) inhibitor panitumumab (Vectibix), a Philadelphia oncologist reported here.

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Quality of life during therapy also improved for patients who followed a skin care program designed to minimize dermatologic side effects of the antibody, Edith Mitchell, M.D., of Thomas Jefferson University, said at the American Society of Clinical Oncology meeting.

"The skin toxicity caused by EGFR inhibitors like panitumumab and cetuximab (Erbitux) can be devastating for patients," Dr. Mitchell said in a statement. "It prevents many patients from agreeing to take these drugs and either delays or interrupts treatment for many others, reducing the effectiveness of therapy."

"Prophylactic skin treatment is likely to become a new standard of care for patients receiving these drugs," she added.

As many as 90% of patients treated with EGFR inhibitors develop an acneiform rash that causes erythema, pruritus, exfoliation, and dryness. The rash can predispose patients to potentially serious skin infections.

Many patients also are distressed by the unsightly appearance of the rash, which results from EGFR inhibitors' binding to receptors that occur in abundance in the skin, said Dr. Mitchell.

Traditionally, skin toxicity has been managed reactively as the rash and other symptoms arise, but Dr. Mitchell and colleagues designed a skin care regimen that patients initiate before signs and symptoms of skin toxicity appear.

The regimen consists of moisturizers, PABA-free sunscreen with an SPF rating ≥15, topical steroid cream, and doxycycline 100 mg twice a day.

Investigators tested the regimen in a randomized clinical study involving 95 patients with unresectable metastatic colorectal cancer. All the patients received treatment that included panitumumab.

The patients were randomized to pre-emptive skin treatment or reactive treatment based on the appearance of signs and symptoms of skin toxicity.

The primary endpoint was the occurrence of grade 2+ skin toxicity at the end of six weeks. Investigators also assessed quality of life by means of the Dermatology Life Quality Index, which patients completed weekly.

When the study ended, the overall incidence of skin toxicity was 62% in patients who were treated reactively compared with 29% in patients who followed the prophylactic regimen.

Specific types of skin toxicity all occurred less often with pre-emptive therapy group.

Quality of life declined by 1.3 units in the preemptive therapy group after three weeks compared with 4.2 units in those randomized to reactive treatment.

At six weeks the change in quality of life averaged 2.0 in the study group and 2.6 in patients assigned to conventional management.

Patients assigned to prophylactic skin care reported feeling better about their appearance, being more comfortable, and having less lifestyle impairment, according to Dr. Mitchell.