Managing dermatologic changes of targeted cancer therapy
Failure to control these dermatologic changes can lead to lower dosages of cancer agents or an interrupted course of Tx. These steps can help you to head off trouble.
PRACTICE RECOMMENDATIONS
› Counsel patients about their risk of rash before epidermal growth factor receptor–targeting treatment is initiated; early recognition of rash and intervention lead to milder symptoms. A
› Encourage daily skin care with an alcohol-free emollient cream. Instruct patients to avoid products that can cause skin drying, prolonged hot showers, perfumes, and soaps marketed for treating acne. B
› Instruct patients that oral hygiene to lower their risk of stomatitis should include a soft-bristle toothbrush and oral rinsing with normal saline—not with an alcohol-based commercial mouthwash. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Does rash correlate with cancer treatment efficacy?
Despite troubling dermatologic effects of cancer therapies, a retrospective analysis of several clinical trials has revealed another side to this coin: namely, the appearance, and the severity, of a rash correlates positively with objective tumor response.14 That correlation allows the oncologist to use a rash as a surrogate marker of treatment efficacy20 (although, notably, there remains a lack of prospective trials that would validate a rash as such a marker). Epidermal growth factor receptor-tyrosine kinase inhibitors are mainly prescribed in patients who harbor an activating EGFR mutation; no studies have stratified patients by EGFR mutation and incidence of rash.33
The upshot? Although there are gaps in our understanding of the relationship between a rash and overall survival, we are nevertheless presented with this paradigm: A patient who is taking an EGFR-tyrosine kinase inhibitor and who develops a rash should be continued on that treatment for as long as can be tolerated, because the rash is presumed to be a sign that the patient is deriving the greatest clinical benefit from therapy.14,20,33
CORRESPONDENCE
Kevin Zarrabi, MD, MSc, Department of Medicine, Health Science Center T16, Room 020, Stony Brook, NY 11790-8160; Kayvan.zarrabi@gmail.com
ACKNOWLEDGMENT
Ali John Zarrabi, MD, provided skillful editing of the manuscript of this article.
