Recommendations for the Prophylactic Management of Skin Reactions Induced by Epidermal Growth Factor Receptor Inhibitors in Patients With Solid Tumors
Open accessAbstract
Inhibition of the epidermal growth factor receptor (EGFR) is an established treatment that extends patient survival across a variety of tumor types. EGFR inhibitors fall into two main categories: anti-EGFR monoclonal antibodies, such as cetuximab and panitumumab, and first-generation tyrosine kinase inhibitors, such as afatinib, gefitinib, and erlotinib. Skin reactions are the most common EGFR inhibitor-attributable adverse event, resulting in papulopustular (acneiform) eruptions that can be painful and debilitating, and which may potentially have a negative impact on patients’ quality of life and social functioning, as well as a negative impact on treatment duration. Shortened treatment duration can, in turn, compromise antineoplastic efficacy. Similarly, appropriate management of skin reactions is dependent on their accurate grading; however, conventional means for grading skin reactions are inadequate, particularly within the context of clinical trials. Treating a skin reaction only once it occurs (reactive treatment strategies) may not be the most effective management approach; instead, prophylactic approaches may be preferable. Indeed, we support the viewpoint that prophylactic management of skin reactions should be recommended for all patients treated with EGFR inhibitors. Appropriate prophylactic management could effectively reduce the severity of skin reactions in patients treated with EGFR inhibitors and therefore has the potential to directly benefit patients and improve drug adherence. Accordingly, here we review published and still-emerging data, and provide practical and evidence-based recommendations and algorithms regarding the optimal prophylactic management of EGFR inhibitor-attributable skin reactions.
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Afatinib-related AEs are manageable by means of tolerability-guided dose adjustments, along with use of AE-specific treatment administered either prophylactically or as needed.
“afatinib-related AEs are manageable by means of tolerability-guided dose adjustments, along with the use of AE-specific treatment administered either prophylactically or as needed.”
From Afatinib for the treatment of <i>EGFR</i> mutation-positive NSCLC: A review of clinical findings (2020) · cites this paper as [90]
The Introduction (page unavailable) describes EGFR-inhibitor adverse events as manageable and says physicians may lower the dose when skin toxicity reaches grade 3 or higher. The Recommendations and Conclusion (pages unavailable) support prophylactic treatment of skin reactions, including those associated with afatinib, but do not establish that all afatinib-related AEs are manageable through tolerability-guided dose adjustments and prophylactic or as-needed AE-specific treatment. The Recommendations caution that reactive skin treatment often occurs too late. (LLM, conf=0.86)
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- Authors
- Hofheinz, R.-D., Deplanque, G., Komatsu, Y., Kobayashi, Y., Ocvirk, J., Racca, P., Guenther, S., Zhang, J., Lacouture, M. E., & Jatoi, A.
- Affiliations
- University Medical Centre Mannheim (DE)
- Département d’Oncologie, Service d’Oncologie Médicale, Lausanne, Switzerland
- Hokkaido University Hospital (JP)
- Kushiro Rosai Hospital (JP)
- Institute of Oncology Ljubljana (SI)
- Fondazione Ricerca Molinette (IT)
- Merck KGaA, Darmstadt (Germany) (DE)
- Ruijin Hospital (CN)
- Memorial Sloan Kettering Cancer Center (US)
- Mayo Clinic (US)
- Corresponding author
- Hofheinz, Ralf-Dieter
- Venue
- The Oncologist
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-07-22
- Volume
- 21
- Issue
- 12
- Pages
- 1483-1491
- ISSN
- 1083-7159 (ISSN-L)
- 1549-490X
- PMC
- PMC5153350
- OpenAlex
- W2504049772
- Cited by
- 88
- References
- 52
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 9 · 2023: 10 · 2022: 4 · 2021: 8 · 2020: 12 · 2019: 11 · 2018: 7 · 2017: 10 · 2015: 1
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Oncologist (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- SERVAL (Université de Lausanne) (publishedVersion, other-oa)
- IRIS (submittedVersion)
- Funders
- NIH
- National Cancer Institute Cancer Center (P30 CA008748)
- Merck KGaA
- Topics
- Health Sciences › Medicine › Dermatology › Chemotherapy-related skin toxicity
- Health Sciences › Medicine › Oncology › HER2/EGFR in Cancer Research
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Keywords
- EGFR inhibitors, skin reactions, acneiform eruption, EGFR tyrosine kinase inhibitors, anti-EGFR monoclonal antibody, cetuximab, panitumumab, gefitinib, erlotinib, afatinib, treatment duration, medication adherence, solid tumors
- MeSH terms
- Algorithms, Humans, Neoplasms, Quality of Life, Skin, Antibiotic Prophylaxis, Protein Kinase Inhibitors, ErbB Receptors
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