Cutaneous Toxicities of Molecular Targeted Therapies

Abstract

Antineoplastic targeted therapies, such as EGFR inhibitors, tyrosine kinase inhibitors and BRAF inhibitors, frequently lead to systemic and cutaneous side effects, significantly affecting patient's quality of life. Patients with new targeted therapies have an increased risk of developing skin reactions. The new molecular target therapies developed in the last decades can induce severe skin reactions, which may require dose reduction or discontinuation of treatment and consequently, a decrease in patient's quality of life. The present paper describes toxic cutaneous reactions associated with the most frequently used molecular therapies (epidermal growth factor receptor inhibitors, tyrosine kinase inhibitors, BRAF-inhibitors), frequency of occurrence and methods of diagnosis and treatment, in order to offer a clinically efficient management for maintaining a good quality of life, with compliance to treatment and good therapeutic efficacy. Knowledge of cutaneous adverse reactions in new therapies is mandatory in order to have a proper management of oncologic patients. Recognizing target therapy toxicities by both oncologists and dermatologists, understanding therapeutic mechanisms and choosing optimum treatments for oncologic patients are critical. A correct evaluation of skin toxicity can allow for an adequate decision regarding treatment dose or discontinuation, impacting therapy response and patient survival.

FIGURE 1.

FIGURE 1. Skin rash consisting of erythematous papules and pustules after anti EGFR therapy (Cetuximab)

FIGURE 2.

FIGURE 2. Skin rash consisting of erythematous violaceous papules and pustules, with fi ne scales, yellow crusts and telangiectasias after anti EGFR therapy (Cetuximab)

FIGURE 3.

FIGURE 3. Up: vesicles and tension bullae on a well defi ned erythematous background on soles (HFS); lower left: well defi ned erythemato-squamous plaques on elbows; lower right: well defi ned erythematous plaques on soles

FIGURE 4.

FIGURE 4. Erythema on the palmar and dorsal aspects of hands, including the fi ngers and nail folds, with desquamation, hyperkeratosis and fi ssures

FIGURE 5.

FIGURE 5. Upper left: periocular papillomas; upper right: erythema multiforme-like lesions, soft bullae with serous fl uid content, surrounded by and erythemato-edematous ring, on a red-violaceous background (targetoid lesions); lower left and right: small, slightly erythematous papules and nodules, (metastases versus dermatofi bromas)