Does sunscreen prevent epidermal growth factor receptor (EGFR) inhibitor-induced rash? Results of a placebo-controlled trial from the North Central Cancer Treatment Group (N05C4).
OBJECTIVE
Rash occurs in >50% of patients prescribed epidermal growth factor receptor (EGFR) inhibitors. This study was undertaken to determine whether sunscreen prevents or mitigates these rashes.


METHODS
This placebo-controlled, double-blinded trial enrolled rash-free patients starting an EGFR inhibitor. Patients were randomly assigned to sunscreen with a sun protection factor of 60 applied twice a day for 28 days versus placebo. They were then monitored for rash and quality of life (Skindex-16) during the 4-week intervention and for an additional 4 weeks.


RESULTS
Fifty-four patients received sunscreen, and 56 received placebo; the arms were balanced at baseline. During the 4-week intervention, physician-reported rash occurred in 38 (78%) and 39 (80%) sunscreen-treated and placebo-exposed patients, respectively (p = 1.00); no significant differences in rash rates emerged over the additional 4 weeks. There were no significant differences in rash severity, and patient-reported outcomes of rash yielded similar conclusions. Adjustment for sun intensity by geographical zone, season, and use of photosensitivity medications did not yield a significant difference in rash across study arms (p = .20). Quality of life scores declined but remained comparable between arms.


CONCLUSIONS
Sunscreen, as prescribed in this trial, did not prevent or attenuate EGFR inhibitor-induced rash.
Jatoi
Aminah
A
Mayo Clinic Foundation, Rochester, Minnesota 55905, USA. jatoi.aminah@mayo.edu
Thrower
Abby
A
Sloan
Jeff A
JA
Flynn
Patrick J
PJ
Wentworth-Hartung
Nicole Lea
NL
Dakhil
Shaker R
SR
Mattar
Bassam I
BI
Nikcevich
Daniel A
DA
Novotny
Paul
P
Sekulic
Aleksandar
A
Loprinzi
Charles L
CL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000068818:Cetuximab; D004311:Double-Blind Method; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D000069347:Erlotinib Hydrochloride; D005076:Exanthema / Q000139:chemically induced / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000523:psychology; D011788:Quality of Life; D011799:Quinazolines / Q000009:adverse effects*; D013473:Sunscreening Agents / Q000009:adverse effects / Q000627:therapeutic use*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D011799:Quinazolines; D013473:Sunscreening Agents; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors; D000068818:Cetuximab
Cancer. 2008 Aug 15;113(4):847-53
18543329
J Biol Chem. 2001 Mar 2;276(9):6320-6
11098053
Photodermatol Photoimmunol Photomed. 2007 Feb;23(1):42-5
17254038
J Cutan Med Surg. 2001 Mar-Apr;5(2):105-10
11443481
J Clin Oncol. 2007 Dec 1;25(34):5390-6
18048820
Cell Signal. 2008 Oct;20(10):1830-8
18644433
J Clin Oncol. 2010 Mar 10;28(8):1351-7
20142600
Clin J Oncol Nurs. 2008 Jun;12(3):405-7
18515238
J Invest Dermatol. 1999 Apr;112(4):443-9
10201527