Isotretinoin plus clindamycin seem highly effective against severe erlotinib-induced skin rash in advanced non-small cell lung cancer.
BACKGROUND
Erlotinib is useful in advanced non-small cell lung cancer although compliance and efficacy are diminished by skin rash in a high proportion of patients, often necessitating dose reduction or drug withdrawal. No effective treatment for the rash is available.


METHODS
We carried out a preliminary investigation on isotretinoin and clindamycin. Among 56 advanced lung cancer patients treated with erlotinib, 31 (53%) developed rash. Seven (35%) of the 20 G2/G3 cases agreed to treatment with clindamycin (450 mg/d, days 1-10; 300 mg/d, days 11-20) plus isotretinoin (20 mg/d, days 11-20) after being informed of the experimental nature of the combination.


RESULTS
In 6 of 7 (86%) patients, the rash resolved (G1/G0) without dose reduction; in the other patient (G3), the erlotinib dose also had to be reduced. Median time to resolution was 14 days (range 7-20 days). No rash-treatment adverse events occurred during 20 days of administration.


CONCLUSIONS
Isotretinoin plus clindamycin promises to be the first effective treatment for erlotinib rash and is being tested further.
Bidoli
Paolo
P
Medical Oncology Unit, S. Gerardo Hospital, Monza, Italy. p.bidoli@hsgerardo.org
Cortinovis
Diego L
DL
Colombo
Ilaria
I
Crippa
Alessandra
A
Cicchiello
Federica
F
Villa
Federica
F
Cazzaniga
Marina E
ME
Altomare
Gianfranco
G
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D002981:Clindamycin / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000627:therapeutic use; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D000069347:Erlotinib Hydrochloride; D005076:Exanthema / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D015474:Isotretinoin / Q000627:therapeutic use*; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D047428:Protein Kinase Inhibitors / Q000009:adverse effects; D011799:Quinazolines / Q000009:adverse effects*; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D003879:Dermatologic Agents; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D002981:Clindamycin; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors; D015474:Isotretinoin