Adverse skin reactions during treatment with cetuximab plus radiotherapy: Multidisciplinary approach to minimize radio-chemotherapy interruption.
BACKGROUND
Antibodies against the epidermal growth factor receptor (EGFR), such as cetuximab, are effective in loco-regional advanced squamous cell carcinoma of the head and neck (SCCHN) in association with radiotherapy. Cutaneous reactions are well known as adverse events during treatment with EGFR inhibitors.


OBJECTIVE
To identify a multidisciplinary approach for mucous-cutaneous toxicity during cetuximab-radiotherapy treatment in order to reduce the risk of an early radio-chemotherapy interruption.


METHODS
The data of 38 patients with SCCHN receiving cetuximab and radiotherapy were retrospectively analyzed. The control group (n = 15) received the standardized treatments according to the severity of skin reactions with dermatologic visits only for high degrees of toxicity. The experimental group (n = 23) was monitored and daily treated by dermatologists since grade 1 of cutaneous toxicity. The primary end-point of our study was the mean days of antitumor therapy interruption.


RESULTS
The mean number of days of antitumor therapy suspension was 12.6 (7.6) in the standard treatment group and 5.0 (6.6) in the experimental group (p = 0.002). This difference was observed for each grade of toxicity.


CONCLUSIONS
The early interruption of radio-chemotherapy has a negative impact on survival in patients with SCCHN. In our study, a closer dermatological examination and treatment for all degrees of toxicity reduced early interruptions of chemo-radiotherapy.
Department of Dermatology, Catholic University of Sacred Heart , Rome , Italy .
Francesco
F
Ricci
Andrea
A
Paradisi
Sara Lanza
SL
Silveri
Francesca
F
Sampogna
Francesco
F
Miccichè
Pier L
PL
Bonomo
Nicola
N
DiNapoli
Vincenzo
V
Valentini
Rodolfo
R
Capizzi
Cristina
C
Guerriero
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D000068818:Cetuximab / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy; D066246:ErbB Receptors / Q000276:immunology; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck
D000970:Antineoplastic Agents; C512478:EGFR protein, human; D066246:ErbB Receptors; D000068818:Cetuximab
Cetuximab; EGFR inhibitors; papulo-pustular rash; radiotherapy; squamous cell carcinoma of head and neck