title: Cetuximab-induced skin exanthema: prophylactic and reactive skin therapy are equally effective.
abstract: Treatment with cetuximab is accompanied by the development of an acneiform follicular skin exanthema in more than 80 % of patients. Severe exanthema (grade III/IV) develops in about 9-19 % of patients with the necessity of cetuximab dose reduction or cessation.
  
  
  
  The study presented was a retrospective analysis of 50 gastrointestinal cancer patients treated with cetuximab in combination with either FOLFIRI or FOLFOX. One cohort of 15 patients received an in-house reactive skin protocol upon development of an exanthema. A second cohort of 15 patients received a skin prophylaxis starting with the first dose of cetuximab before clinical signs of toxicity. A third historic group of 20 patients had received no skin prophylaxis or reactive treatment.
  
  
  
  19/20 patients of the historic group developed a skin exanthema. Grade III/IV exanthema was observed six times. Forty percent discontinued cetuximab therapy. The average time to exanthema onset was 14.7 days. Applying the reactive skin protocol after the first occurrence of an exanthema, the exanthema was downgraded as follows: No patients developed grade IV° exanthema, and two patients developed a grade II/III exanthema. In the majority of cases, the reactive skin protocol controlled the exanthema (grade 0-I°). No dose reductions in cetuximab were necessary. Applying the prophylactic skin protocol starting at the beginning of cetuximab application was not superior to the reactive skin protocol.
  
  
  
  Cetuximab-induced skin exanthema can be coped with a reactive protocol equally effective as compared to a prophylactic skin treatment. A prospective study with higher patient numbers is planned.
authors.affiliation: Third Department of Internal Medicine, Johannes Gutenberg University of Mainz, Mainz, Germany, thomas.wehler@unimedizin-mainz.de.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Wehler
authors.forename: Claudine
authors.initials: C
authors.lastname: Graf
authors.forename: Markus
authors.initials: M
authors.lastname: Möhler
authors.forename: Jutta
authors.initials: J
authors.lastname: Herzog
authors.forename: Martin R
authors.initials: MR
authors.lastname: Berger
authors.forename: Ines
authors.initials: I
authors.lastname: Gockel
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
authors.forename: Matthias
authors.initials: M
authors.lastname: Theobald
authors.forename: Peter R
authors.initials: PR
authors.lastname: Galle
authors.forename: Carl C
authors.initials: CC
authors.lastname: Schimanski
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000068818:Cetuximab; D003902:Detergents / Q000627:therapeutic use; D005076:Exanthema / Q000139:chemically induced / Q000628:therapy*; D024841:Fluoroquinolones / Q000008:administration & dosage*; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage; D008911:Minocycline / Q000008:administration & dosage*; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives; D011807:Quinolizines / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome; D010837:Vitamin K 1 / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D003902:Detergents; D024841:Fluoroquinolones; D011807:Quinolizines; D008795:Metronidazole; C062127:nadifloxacin; D010837:Vitamin K 1; D011239:Prednisolone; D008911:Minocycline; D000068818:Cetuximab; C035287:prednicarbate
references.citation: Lancet Oncol. 2012 Mar;13(3):300-8
references.pmid: 22277837
references.citation: J Clin Oncol. 2004 Apr 1;22(7):1201-8
references.pmid: 14993230
references.citation: J Immunother. 2012 Jun;35(5):367-73
references.pmid: 22576341
references.citation: Pulm Pharmacol Ther. 2007;20(6):669-75
references.pmid: 17045828
references.citation: J Am Acad Dermatol. 1986 Feb;14(2 Pt 1):183-6
references.pmid: 2936772
references.citation: Br J Dermatol. 2001 Jun;144(6):1169-76
references.pmid: 11422037
references.citation: J Clin Oncol. 2007 Dec 1;25(34):5390-6
references.pmid: 18048820
references.citation: Dermatology. 1998;196(1):135-9
references.pmid: 9557248
references.citation: J Clin Oncol. 2010 Mar 10;28(8):1351-7
references.pmid: 20142600
references.citation: J Am Acad Dermatol. 2009 Oct;61(4):614-20
references.pmid: 19646778
references.citation: Cancer. 2008 Aug 15;113(4):847-53
references.pmid: 18543329
references.citation: Int J Cancer. 2013 Jan 1;132(1):236-45
references.pmid: 22644776
references.citation: Support Care Cancer. 2011 Aug;19(8):1079-95
references.pmid: 21630130