title: Management of dermatologic toxicities associated with monoclonal antibody epidermal growth factor receptor inhibitors: A case review.
abstract: BACKGROUND
  The epidermal growth factor receptor inhibitors (EGFRIs), cetuximab and panitumumab, represent an effective treatment option for patients affected by metastatic colorectal cancer (mCRC); furthermore, they are relatively devoid of systemic toxicities, which are commonly observed with standard cytotoxic chemotherapy. However, the majority of patients treated with these monoclonal antibodies (mAbs), will experience dermatologic toxicities, most notably the papulopustular skin rash, which can impact quality-of-life and affect adherence to therapy. This paper reviews the most recent practices in the management of skin rash related to anti-epidermal growth factor receptor (EGFR) mAbs, cetuximab and panitumumab, in the treatment of mCRC.
  
  
  METHODS
  We reviewed relevant literature regarding dermatologic toxicities associated with anti-EGFR mAbs in order to give important indications about prevention and reactive treatment of skin rash.
  
  
  RESULTS
  Two case reports were presented to show how skin rash could hamper mAb EGFRIs use in clinical practice, underscoring the need of implementing a comprehensive management strategy of skin toxicity in order to promote patients' compliance with anti-EGFR therapy and maintain quality-of-life. Based on randomized data, recent guidelines established by the Multinational Association for Supportive Care in Cancer Skin Toxicity Study Group suggest that prophylactic use of oral doxycycline or minocycline reduces the risk and severity of skin rash, improving clinical outcomes.
  
  
  CONCLUSIONS
  At the start of treatment with cetuximab and panitumumab, the proper patient education about the skin rash associated with these mAbs and the implementation of a pre-emptive, comprehensive skin toxicity program significantly contribute to improve adherence to therapy, optimize anti-EGFR therapy and maintain quality-of-life.
authors.affiliation: Department of Science of Health, School of Medicine, University of Catanzaro, Catanzaro, Italy ; Pharmacovigilance's Centre Calabria Region, University Hospital Mater Domini, Catanzaro, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Leporini
authors.affiliation: Department of Science of Health, School of Medicine, University of Catanzaro, Catanzaro, Italy ; Pharmacovigilance's Centre Calabria Region, University Hospital Mater Domini, Catanzaro, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Saullo
authors.affiliation: Oncology Unit, S. Francesco di Paola Hospital, Paola Province of Cosenza, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Filippelli
authors.affiliation: Pharmacy Unit, S. Francesco di Paola Hospital, Paola Province of Cosenza, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sorrentino
authors.affiliation: Oncology Unit, S. Francesco di Paola Hospital, Paola Province of Cosenza, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Lucia
authors.affiliation: Oncology Unit, S. Francesco di Paola Hospital, Paola Province of Cosenza, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Perri
authors.affiliation: Oncology Unit, S. Francesco di Paola Hospital, Paola Province of Cosenza, Italy.
authors.forename: Gaetana La
authors.initials: GL
authors.lastname: Gattuta
authors.affiliation: Oncology Unit, S. Francesco di Paola Hospital, Paola Province of Cosenza, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Infusino
authors.affiliation: Oncology Unit, S. Francesco di Paola Hospital, Paola Province of Cosenza, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Toscano
authors.affiliation: Oncology Unit, S. Francesco di Paola Hospital, Paola Province of Cosenza, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Dima
authors.affiliation: Oncology Unit, S. Francesco di Paola Hospital, Paola Province of Cosenza, Italy.
authors.forename: Virginia
authors.initials: V
authors.lastname: Olivito
authors.affiliation: Department of Science of Health, School of Medicine, University of Catanzaro, Catanzaro, Italy ; Pharmacovigilance's Centre Calabria Region, University Hospital Mater Domini, Catanzaro, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Paletta
authors.affiliation: Department of Science of Health, School of Medicine, University of Catanzaro, Catanzaro, Italy ; Pharmacovigilance's Centre Calabria Region, University Hospital Mater Domini, Catanzaro, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Bottoni
authors.affiliation: Department of Science of Health, School of Medicine, University of Catanzaro, Catanzaro, Italy ; Pharmacovigilance's Centre Calabria Region, University Hospital Mater Domini, Catanzaro, Italy.
authors.forename: Giovambattista
authors.initials: G
authors.lastname: De Sarro
keywords: Cetuximab; dermatologic toxicity; panitumumab; rash; safety