Dermatologic Toxicity Occurring During Anti-EGFR Monoclonal Inhibitor Therapy in Patients With Metastatic Colorectal Cancer

A Systematic Review

Mario E. Lacouture, Milan Anadkat, Aminah Jatoi, Tamer Garawin, Chet Bohac, Edith Mitchell

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Monoclonal antibody inhibitors of the epidermal growth factor receptor (EGFR) have been shown to improve outcomes for patients with metastatic colorectal cancer (mCRC) without RAS gene mutations. However, treatment with anti-EGFR agents can be associated with toxicities of the skin, nails, hair, and eyes. Because these dermatologic toxicities can result in treatment discontinuation and affect patient quality of life, their management is an important focus when administering anti-EGFR monoclonal antibodies. The present systematic review describes the current data reporting the nature and incidence of, and management and treatment options for, dermatologic toxicities occurring during anti-EGFR treatment of mCRC. A search of the National Library of Medicine PubMed database from January 1, 2009, to August 18, 2016, identified relevant reports discussing dermatologic toxicity management among patients with mCRC receiving anti-EGFR therapy. The studies were grouped by type and rated by level of evidence using the GRADE approach developed by the Agency for Healthcare Research and Quality. Overall, 269 reports were reviewed (nonrandomized trials, n = 120; randomized trials, n = 31; retrospective studies, n = 15; reviews, n = 39). Dermatologic toxicity of any grade occurs in most patients who receive anti-EGFR therapy; approximately 10% to 20% of patients experienced grade 3/4 toxicity. The most common dermatologic toxicities include papulopustular/acneiform rash, xerosis, and pruritus; however, nail changes, hair abnormalities, and ocular conditions also occur. Guidance for managing these toxicities includes the use of inexpensive emollient ointments and moisturizers, avoidance of sun exposure, avoidance of irritants, and the use of short showers. Several studies also found that preemptive treatment was more effective than reactive treatment at limiting the incidence and severity of skin toxicity. With appropriate treatment, the dermatologic toxicities associated with anti-EGFR monoclonal antibody therapy can be managed, minimizing patient discomfort and the need for therapy interruption and/or discontinuation. Additionally, preemptive treatment can reduce dermatologic toxicity severity, ultimately yielding better quality of life.

Original languageEnglish (US)
JournalClinical Colorectal Cancer
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Epidermal Growth Factor Receptor
Colorectal Neoplasms
Therapeutics
Monoclonal Antibodies
Nails
Hair
Quality of Life
Emollients
National Library of Medicine (U.S.)
Skin
Irritants
Health Services Research
Incidence
Solar System
Pruritus
Ointments
Exanthema
PubMed
Research Design
Retrospective Studies

Keywords

  • Dermatologic toxicity management
  • Epidermal growth factor receptor
  • Patient outcomes
  • Skin toxicity

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

Dermatologic Toxicity Occurring During Anti-EGFR Monoclonal Inhibitor Therapy in Patients With Metastatic Colorectal Cancer : A Systematic Review. / Lacouture, Mario E.; Anadkat, Milan; Jatoi, Aminah; Garawin, Tamer; Bohac, Chet; Mitchell, Edith.

In: Clinical Colorectal Cancer, 01.01.2018.

Research output: Contribution to journalArticle

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