title: Folliculitis induced by EGFR inhibitors, preventive and curative efficacy of tetracyclines in the management and incidence rates according to the type of EGFR inhibitor administered: a systematic literature review.
abstract: BACKGROUND
  Folliculitis is the most common side effect of epidermal growth factor receptor (EGFR) inhibitors (EGFRIs). It is often apparent, altering patients' quality of life and possibly impacting compliance. Variations in terms of the treatment-related incidence and intensity have not been fully elucidated. Tetracyclines have been recommended for the prophylaxis and treatment of folliculitis but their efficacy is yet to be established.
  
  
  METHODS
  We carried out two systematic literature reviews. The first assessed the preventive and curative efficacy of tetracyclines. The second assessed the incidence of grade 3-4 folliculitis in the main clinical studies published.
  
  
  RESULTS
  In four randomized studies, preventive tetracycline treatment was associated with a significantly lower incidence of grade 2-3 folliculitis and a better quality of life in three of the four studies. In curative terms, tetracycline efficacy was not evaluated in any randomized study, but an improvement in grade ≥2 folliculitis was reported in case series. The frequency and severity of folliculitis seem to be greater with the antibodies than with the tyrosine kinase inhibitors. Analysis restricted to lung cancer studies showed a statistically greater incidence in terms of grade 3-4 folliculitis with cetuximab (9%) and erlotinib (8%) than with gefitinib (2%) (p < .0001).
  
  
  CONCLUSIONS
  Unless contraindicated, a tetracycline should be routinely prescribed prophylactically for patients treated with an EGFRI (level of evidence, B2). In curative therapy, the level of evidence for tetracycline efficacy is low (level of evidence, D). The incidence of grade 3-4 folliculitis induced by EGFRIs appears to be lower with gefitinib.
authors.affiliation: Department of Hepato-Gastro-Enterology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre & Marie Curie, Paris, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Bachet
authors.forename: Lucie
authors.initials: L
authors.lastname: Peuvrel
authors.forename: Claude
authors.initials: C
authors.lastname: Bachmeyer
authors.forename: Ziad
authors.initials: Z
authors.lastname: Reguiai
authors.forename: Pierre A
authors.initials: PA
authors.lastname: Gourraud
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouché
authors.forename: Marc
authors.initials: M
authors.lastname: Ychou
authors.forename: Rene J
authors.initials: RJ
authors.lastname: Bensadoun
authors.forename: Brigitte
authors.initials: B
authors.lastname: Dreno
authors.forename: Thierry
authors.initials: T
authors.lastname: André
mesh_terms: D066246:ErbB Receptors / Q000037:antagonists & inhibitors* / Q000378:metabolism; D005499:Folliculitis / Q000139:chemically induced* / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D013754:Tetracyclines / Q000627:therapeutic use*
chemical_list: D047428:Protein Kinase Inhibitors; D013754:Tetracyclines; D066246:ErbB Receptors