title: Efficacy and skin toxicity management with cetuximab in metastatic colorectal cancer: outcomes from an oncologic/dermatologic cooperation.
abstract: OBJECTIVE
  The aim of this study was to investigate the efficacy of the combination of irinotecan/cetuximab and to plan related skin toxicity management with an oncologic/dermatologic team.
  
  
  METHODS
  Thirty-four patients with epidermal growth factor receptor (EGFR)-expressing metastatic colorectal cancer received cetuximab 400 mg/m2 as an initial dose and 250 mg/m2 weekly thereafter. In addition, patients received irinotecan 180 mg/m2 every 2 weeks.
  
  
  RESULTS
  Thirty-two patients were evaluated for response rate (RR) and skin toxicity to establish the best management. In our study, the responses observed with cetuximab treatment were complete response in 1 patient (3%), partial response in 11 patients (34%), disease stabilization in 6 patients (19%), and progressive disease in 14 patients (44%). Of 34 patients evaluable for cutaneous toxicity, 10 patients (29%) presented with grade 1 eruption, 13 (38%) with grade 2 eruption, and 4 (12%) with grade 3 eruption. Allergic reactions such as flushing and urticaria (grade 2) were seen in 2 patients (6%).
  
  
  CONCLUSIONS
  Cutaneous reactions consisted of follicular rash, xerosis, painful fissures in palms and soles, alterations in hair growth, and mucositis. In the majority of patients (80%-90%), the worst recorded skin effects were mild (grade 1) to moderate (grade 2). The incidence of severe cases (grade 3) was approximately 15%. All dermatologic effects were reversible and generally without sequelae within 4 weeks after treatment discontinuation. We observed significant correlations between degree of cutaneous toxicity and increased RR. Correct identification and treatment by oncologic/dermatologic cooperation of EGFR cutaneous side effects help to improve quality of life.
authors.affiliation: Centro Universitario di Ricerca Oncologica, Oncologia Medica I, ASO San Giovanni Battista Ospedale Molinette, Torino, Italy. p.racca@tin.it
authors.forename: Patrizia
authors.initials: P
authors.lastname: Racca
authors.forename: Laura
authors.initials: L
authors.lastname: Fanchini
authors.forename: Virginia
authors.initials: V
authors.lastname: Caliendo
authors.forename: Giuliana
authors.initials: G
authors.lastname: Ritorto
authors.forename: Walter
authors.initials: W
authors.lastname: Evangelista
authors.forename: Roberta
authors.initials: R
authors.lastname: Volpatto
authors.forename: Enrica
authors.initials: E
authors.lastname: Milanesi
authors.forename: Angelica
authors.initials: A
authors.lastname: Ciorba
authors.forename: Myriam
authors.initials: M
authors.lastname: Paris
authors.forename: Ivan
authors.initials: I
authors.lastname: Facilissimo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Macripò
authors.forename: Mario
authors.initials: M
authors.lastname: Clerico
authors.forename: Libero
authors.initials: L
authors.lastname: Ciuffreda
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068818:Cetuximab; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D000077146:Irinotecan; D009362:Neoplasm Metastasis; D012871:Skin Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology*
chemical_list: D000891:Anti-Infective Agents, Local; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000077146:Irinotecan; D000068818:Cetuximab; D002166:Camptothecin