Cutaneous side effects of new antitumor drugs: clinical features and management

Abstract

Background: Many new antitumor drugs have been approved in recent years. Their side-effect profiles are distinct from those of older drugs, and their adverse effects are sometimes highly specific, particularly with respect to the skin.

Methods: This article is based on articles retrieved by a selective search in Medline and the database of the American Society of Clinical Oncology (ASCO), as well as on the authors' personal experience.

Results: Cutaneous adverse effects are among the more common adverse effects of new antitumor drugs: they occur in up to 34% of patients receiving multikinase inhibitors, up to 90% of those receiving selective tyrosine kinase inhibitors (such as EGFR or mutant BRAF inhibitors), and up to 68% of those receiving immunotherapeutic agents (such as CTLA4 inhibitors). These adverse effects can be correlated with therapeutic benefit, but they can also be treatment-limiting because of their severity or visibility.

Conclusion: The recognition and proper management of cutaneous adverse effects is an important part of treatment with new antitumor drugs.

Figure 1

Intensity and time-course of the most common cutaneous adverse events during EGFR inhibition

Figure 2

Papulopustular rash during treatment with the EGFR-inhibitor cetuximab

Figure 3

Paronychia with granulation tissue during treatment with the EGFR-inhibitor cetuximab

Figure 4

Maculo-papular rash during treatment with the multikinase inhibitor sorafenib

Figure 5

Hand-foot syndrome during treatment with the multikinase inhibitor sorafenib

Figure 6

Hand-foot syndrome (palmar-plantar erythrodysesthesia) during treatment with pegylated liposome-encapsulated doxorubicin

Figure 7

Papular urticarial rash during treatment with the anti-CTLA-4-antibody ipilimumab