Treatment of epidermal growth factor receptor antagonist-induced skin rash: results of a survey among German oncologists.
BACKGROUND
Skin toxicities are frequent in patients receiving epidermal growth factor receptor (EGFR) antagonists. Grading and management of these skin reactions are poorly standardized.


METHODS
We conducted a survey among German oncologists using a 7-item questionnaire distributed by e-mail via the working groups Internistische Onkologie (AIO) and Dermatologische Onkologie (ADO). The oncologists were provided with pictures and history of a patient with an acneiform rash and were asked to provide information on grading and treatment strategies.


RESULTS
106 medical oncologists and 43 dermatooncologists responded to the survey. The scoring of the skin rash was indicated as follows (National Cancer Institute common toxicity criteria (NCICTC) grades 1/2/3;%): 10/59/31. 22% of the polled medical oncologists use preemptive treatment of skin rash. In the presented case, 91% chose local treatment with mainly hydrocortisone or antibiotic cream, and 64% chose systemic treatment with an antibiotic or isotretinoin. Only 9% of the medical oncologists would have referred the patient to a dermatologist. Dermatooncologists used more local antibiotics (p = 0.006) and rather less local steroids (p = 0.199). With regard to systemic treatment, dermatooncologists more often used isotretinoin (p = 0.002). In addition, dermatooncologists less often delayed cetuximab treatment because of skin toxicity (p = 0.009).


CONCLUSIONS
The results of the present analysis illustrate that grading and treatment of EGFR antagonistinduced skin toxicities are very heterogeneous. Clearly, more randomized trials and a simple and reliable grading system are warranted.
Hassel
Jessica C
JC
Clinical Cooperation Unit for Dermatooncology, German Cancer Research Center (DKFZ) Heidelberg, Germany. j.hassel@dkfz.de
Kripp
Melanie
M
Al-Batran
Salah
S
Hofheinz
Ralf-Dieter
RD
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D015897:Comorbidity; D003879:Dermatologic Agents / Q000627:therapeutic use*; D003875:Drug Eruptions / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence
D000970:Antineoplastic Agents; D003879:Dermatologic Agents; D066246:ErbB Receptors