Epidermal growth factor receptor inhibitors: a review of cutaneous adverse events and management

Abstract

Epidermal growth factor inhibitors (EGFRI), the first targeted cancer therapy, are currently an essential treatment for many advance-stage epithelial cancers. These agents have the superior ability to target cancers cells and better safety profile compared to conventional chemotherapies. However, cutaneous adverse events are common due to the interference of epidermal growth factor receptor (EGFR) signaling in the skin. Cutaneous toxicities lead to poor compliance, drug cessation, and psychosocial discomfort. This paper summarizes the current knowledge concerning the presentation and management of skin toxicity from EGFRI. The common dermatologic adverse events are papulopustules and xerosis. Less common findings are paronychia, regulatory abnormalities of hair growth, maculopapular rash, mucositis, and postinflammatory hyperpigmentation. Radiation enhances EGFRI rash due to synergistic toxicity. There is a positive correlation between the occurrence and severity of cutaneous adverse effects and tumor response. To date, prophylactic systemic tetracycline and tetracycline class antibiotics have proven to be the most effective treatment regime.

Figure 1

Papulopustular eruption. A 52-year-old man with non-small-cell lung carcinoma stage IV developed papulopustules 6 days after erlotinib was commenced.

Figure 2

Xerosis. Ill-defined dried scaly patch with mild erythema on the left leg, occurring 3 weeks following gefitinib. Notice scattered pustules, showing evidence that xerosis took place where papulopustules have developed.

Figure 3

Trichomegaly. Trichomegaly developed in a 40-year-old woman, 3 months preceding erlotinib. Notice the wavy, curly, and aberrant elongation of the eyelashes.

Figure 4

Scalp pustule and scaring alopecia. A 78-year-old woman developed follicular centered pustular eruption on the scalp and scaring alopecia after 3 months of erlotinib.

Figure 5

Papulopustules on irradiated area. A 65-year-old-man with non-small-cell lung cancer stage IV and cauda equina syndrome was admitted for radiation. Erlotinib was given 7 days ago. After 2 days of radiotherapy he developed papulopustular eruption predominantly on the irradiation field.