title: Pre-emptive skin toxicity treatment for anti-EGFR drugs: evaluation of efficacy of skin moisturizers and lymecycline. A phase II study.
abstract: BACKGROUND
  Anti-epidermal growth factor receptor (EGFR) target therapies like erlotinib for metastatic lung cancer and cetuximab or panitumumab for metastatic colorectal cancer (mCRC) cause skin reaction that seems to be related to treatment efficacy. Skin toxicity evaluation protocol with panitumumab study has shown that preemptive treatment reduces the incidence of ≥Grade 2 (G2) skin toxicity in mCRC treated with panitumumab. Aim of this study is to evaluate if preemptive skin toxicity treatment with different drugs has good efficacy in patients receiving anti-EGFR therapies, such as cetuximab, panitumumab, and erlotinib, for mCRC and metastatic lung cancer.
  
  
  METHODS
  Treatment included skin moisturizers with sunscreen and lymecycline 300 mg/daily. Primary objective is to reduce the incidence of ≥G2 skin toxicity during the first 3 months of therapy. Toxicities are reported with confidence interval at 95%. Quality of life was assessed with Dermatology Life Quality Index every 2 weeks and evaluated with repeated measure ANOVA.
  
  
  RESULTS
  Fifty-one patients with mCRC (60.8%) and metastatic lung cancer (39.2%) were enrolled. Anticancer drugs were erlotinib/cetuximab/panitumumab 20:30:1. At 3-month evaluation, 27.4% patients had =G2 skin toxicity. Skin toxicity was not related with age (p = 0.67), sex (p = 0.65), previous chemotherapy regimens (p = 0.41), and current anti-EGFR treatment (p = 0.22). No gastrointestinal or hematological toxicities related to lymecycline were observed. Only six patients required further drugs. Quality of life analysis did not show a significant difference from the beginning and the end of treatment.
  
  
  CONCLUSIONS
  Data show efficacy of preemptive treatment with a well-tolerated profile. A reduction of severe skin toxicities is shown with an increase of grade 1 toxicities, not leading to anti-EGFR dose reduction and with better quality of life for patients.
authors: Medical Oncology Unit, ASL Frosinone, Frosinone, Italy. robertagrande@virgilio.it
authors: Roberta
authors: R
authors: Grande
authors: Filomena
authors: F
authors: Narducci
authors: Sara
authors: S
authors: Bianchetti
authors: Giovanni
authors: G
authors: Mansueto
authors: Donatello
authors: D
authors: Gemma
authors: Isabella
authors: I
authors: Sperduti
authors: Giorgio
authors: G
authors: Trombetta
authors: Franco
authors: F
authors: Angelini
authors: Teresa
authors: T
authors: Gamucci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000068818:Cetuximab; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000556:secondary; D003875:Drug Eruptions / Q000188:drug therapy / Q000517:prevention & control*; D004643:Emollients / Q000008:administration & dosage*; D066246:ErbB Receptors / Q000378:metabolism; D000069347:Erlotinib Hydrochloride; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008194:Lymecycline / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D000077544:Panitumumab; D047428:Protein Kinase Inhibitors / Q000009:adverse effects; D011799:Quinazolines / Q000009:adverse effects*; D012867:Skin / Q000378:metabolism / Q000473:pathology; D013473:Sunscreening Agents / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D004643:Emollients; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D013473:Sunscreening Agents; D000077544:Panitumumab; D008194:Lymecycline; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors; D000068818:Cetuximab