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. 2013 Oct;139(10):1667-72.
doi: 10.1007/s00432-013-1483-4. Epub 2013 Aug 7.

Cetuximab-induced skin exanthema: prophylactic and reactive skin therapy are equally effective

Thomas C Wehler  1 , Claudine Graf, Markus Möhler, Jutta Herzog, Martin R Berger, Ines Gockel, Hauke Lang, Matthias Theobald, Peter R Galle, Carl C Schimanski
Affiliations

Cetuximab-induced skin exanthema: prophylactic and reactive skin therapy are equally effective

Thomas C Wehler et al. J Cancer Res Clin Oncol. 2013 Oct.

Erratum in

Abstract

Purpose: Treatment with cetuximab is accompanied by the development of an acneiform follicular skin exanthema in more than 80 % of patients. Severe exanthema (grade III/IV) develops in about 9-19 % of patients with the necessity of cetuximab dose reduction or cessation.

Methods: The study presented was a retrospective analysis of 50 gastrointestinal cancer patients treated with cetuximab in combination with either FOLFIRI or FOLFOX. One cohort of 15 patients received an in-house reactive skin protocol upon development of an exanthema. A second cohort of 15 patients received a skin prophylaxis starting with the first dose of cetuximab before clinical signs of toxicity. A third historic group of 20 patients had received no skin prophylaxis or reactive treatment.

Results: 19/20 patients of the historic group developed a skin exanthema. Grade III/IV exanthema was observed six times. Forty percent discontinued cetuximab therapy. The average time to exanthema onset was 14.7 days. Applying the reactive skin protocol after the first occurrence of an exanthema, the exanthema was downgraded as follows: No patients developed grade IV° exanthema, and two patients developed a grade II/III exanthema. In the majority of cases, the reactive skin protocol controlled the exanthema (grade 0-I°). No dose reductions in cetuximab were necessary. Applying the prophylactic skin protocol starting at the beginning of cetuximab application was not superior to the reactive skin protocol.

Conclusions: Cetuximab-induced skin exanthema can be coped with a reactive protocol equally effective as compared to a prophylactic skin treatment. A prospective study with higher patient numbers is planned.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
TKI-associated acneiform exanthema. TKI associated acneiform exanthema is classified according NCI CTCAE3.0
Fig. 2
Fig. 2
Prophylactic treatment regimen applied to group C and reactive treatment regimen applied to group B
Fig. 3
Fig. 3
Occurrence of symptoms. Occurrence of maximum acneiform exanthema in the historic cohort A compared to the “reactive treatment” cohort B and “prophylactic treatment” group C
Fig. 4
Fig. 4
Frequency of therapy interruption. The “historic” cohort shows a frequency of 40 % therapy interruption compared to 0 % in cohort B and 7 % in cohort C
Fig. 5
Fig. 5
Time to occurrence of ≥grade II exanthema. No significant difference between the three cohorts exits in terms of time to first exanthema occurrence
See this image and copyright information in PMC

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