HER2 Support Group Forums - Another update on triciaK

Here's the info that was shared 2-3 years ago as a response to Tykerb rash.... please take it to your doctor and see if it will help. You definitely want to stay on Tykerb/Xeloda as long as it is working against the cancer, in my opinion.

*Employ a proactive approach in managing skin reactions.
*Suggest that patients use a thick, alcohol-free emollient cream.
*Suggest that patients use a sunscreen of SPF 25 or higher, preferably
containing zinc oxide or titanium dioxide
* If patient presents with rash, verify appropriate administration of drug and proceed with the following therapy algorithm:

Mild:
Minimally located
No impact on activities of daily life (ADL)
No sign of superinfection

Continue EGFR targeted treatment @current dose and monitor for change in severity.

topical hydrocortisone 1% or 2.5% cream and/or Clindamycin 1% gel

Reassess after 2 weeks, if reaction worsens or does not improve, proceed to next step.

Moderate:
Generalized
Mild Symptoms (e.g. pruritus, tenderness)
Minimal impact on ADL
No sign of superinfection

Continue EGFR targeted treatment @current dose and monitor for change in severity. Continue treatment of the skin reaction with the following:

Hydrocortisone 2.5% cream or Clindamycin 1% gel
or Pimecrolimus 1% cream
Plus Doxycycline 100mg BID or Monocycline 100mg BID

Reassess after 2 weeks, if reaction worsens or does not improve, proceed to next step.

Severe:
Generalized
Severe symptoms (e.g. pruritus, tenderness)
Significant impact on ADL
Potential sign of superinfection

Reduce EGFR targeted therapy as per label and monitor for change in severity. Continue treatment of skin reaction with the following:

Hydrocortisone 2.5% cream or Clindamycin 1% gel
or Pimecrolimus 1% cream
Plus Doxycycline 100mg BID or Monocycline 100mg BID
Plus Medrol dose pack

Reassess after 2 weeks, if reaction worsens, dose interruption or discontinuation may be necessary.

and then there's this from an abstract that I found from Dec 2009...
Rash
A common toxicity associated with lapatinib is skin rash. In the initial phase I study of lapatinib monotherapy, rash was reported in 31% of patients [20]. Similar rates of rash have been reported across the lapatinib clinical trials [22–30]. In the large phase III trial of lapatinib plus capecitabine versus capecitabine alone, 28% of patients in the combination arm experienced rash, versus 15% in the capecitabine alone arm [27]. The vast majority of rash cases were mild to moderate (grade 1 or 2), with grade 3 rash seen in 1% of patients in both the combination arm and the capecitabine-alone arm.
The characteristic rash of lapatinib is shown in Figure 2. This rash has been seen as a class effect of drugs that target the ErbB-1 receptor. These targeted drugs also include the agents erlotinib, cetuximab, and gefitinib [38]. The drug-associated rash is characterized by inflammatory papules and pustules most often seen on the face, chest, and back and may resemble folliculitis or an acneiform drug eruption. The distribution is termed acneiform because the lesions are present at sites with large numbers of pilosebaceous units such as the scalp, face, neck, and upper trunk. However, the characteristic rash is different from classic acne vulgaris because of its lack of comedones. Histologic sections from patients who developed rashes while receiving cetuximab reveal suppurative folliculitis and superficial perifolliculitis as the most common histologic changes with microcomedones notably absent [39].

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Figure 2. A typical papular eruption on the face following lapatinib therapy. (Photo courtesy of Nancy U. Lin, M.D., and Margaret A. Haldoupis, R.N.)

The presence of rash in patients on the ErbB-1 inhibitors gefitinib, erlotinib, and cetuximab has been associated with superior radiographic response and symptom benefit [40, 41]. This observation led to speculation that the same may be true with lapatinib. While there has been no clear evidence to date of an association between rash and clinical benefit from lapatinib in breast cancer, a phase II study of lapatinib in patients with advanced liver, gallbladder, and bile duct cancers found that 20 of the 57 patients enrolled in the study developed a skin rash [42].