title: The management of EGFR inhibitor adverse events: a case series and treatment paradigm.
abstract: BACKGROUND
  Epidermal growth factor receptor (EGFR) inhibitors are widely used medications in the treatment of cancers.
  
  
  OBJECTIVE
  To review the cutaneous adverse events related to EGFR inhibitors.
  
  
  METHODS
  A retrospective chart review of all cases referred for the management of cutaneous adverse events after the initiation of EGFR inhibitor therapy between the years of 2006 and 2009 was performed. The study was approved by the institutional review board.
  
  
  RESULTS
  Four men and 11 women had cutaneous adverse events while receiving erlotinib (mean dose: 112.5 mg) for lung and pancreatic cancer. The most common cutaneous adverse reaction observed was a papulopustular rash in 12 cases (80%). Eczema and xerosis were the only findings in three patients, alopecia in one case, and nail changes in three cases. The treatment modalities prescribed were doxycycline and topical antibiotics for the papulopustular rash; topical high potency steroids, tacrolimus, pimecrolimus, and moisturizers for xerosis and eczema; and cetirizine for the pruritus. The paronychia was treated with warm soaks, topical steroids, and podiatry referral. The majority of patients improved with symptomatic therapy, with the exception of one patient who experienced herpes zoster super infection and Stevens-Johnson syndrome. The patient was hospitalized and required discontinuation of the erlotinib therapy.
  
  
  CONCLUSIONS
  The most common cutaneous adverse event in our cohort was papulopustular rash, followed by eczema and xerosis. Patients were managed with symptom target therapy, and suspension of the EGFR inhibitor was rarely required. As the use of EGFR inhibitors increases, it is important to promptly identify and treat adverse events. Further studies are necessary to develop targeted therapeutic and preventative measures.
authors.affiliation: Departments of Dermatology and Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Amelia M
authors.initials: AM
authors.lastname: Wnorowski
authors.forename: Aieska
authors.initials: A
authors.lastname: de Souza
authors.forename: Abraham
authors.initials: A
authors.lastname: Chachoua
authors.forename: David E
authors.initials: DE
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003875:Drug Eruptions / Q000188:drug therapy* / Q000209:etiology*; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D000069347:Erlotinib Hydrochloride; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy; D011799:Quinazolines / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors