title: Predictors of Tumor Response to Cetuximab and Panitumumab in 116 Patients and a Review of Approaches to Managing Skin Toxicity.
abstract: OBJECTIVE
  Cetuximab and panitumumab are monoclonal antibodies that target the epidermal growth factor receptor (EGFR) in the treatment of metastatic colorectal cancer. Most patients develop a papulopustular rash, which may predict tumor response. We studied whether the other adverse cutaneous effects associated with these monoclonal antibodies are also clinical predictors of response. We also reviewed publications describing approaches to treating the papulopustular rash since no evidence-based guidelines have yet been published.
  
  
  METHODS
  We performed a retrospective study of 116 patients with metastatic colorectal cancer receiving anti-EGRF therapy with cetuximab or panitumumab at Hospital Universitario Donostia.
  
  
  RESULTS
  In total, 81.9% of the patients developed a papulopustular rash. Patients who received the most cycles of treatment with the EGFR inhibitor were at the highest risk of developing the rash, and these patients also had the most severe rash reactions (P=.03). All of the patients who exhibited a complete tumor response had the rash, and the incidence of rash was lower in patients with poor tumor response (P=.03). We also observed an association between tumor response and xerosis (53.4% of the patients who developed xerosis also exhibited tumor response, P=.002). The papulopustular rash was managed according to an algorithm developed by our department.
  
  
  CONCLUSIONS
  Severe papulopustular rash and xerosis may be clinical predictors of good response to anti-EGFR therapy. Patients who develop a papulopustular rash should be treated promptly because suboptimal treatment of this and other adverse effects can lead to delays in taking the prescribed anti-EGFR dose or to interruption of therapy.
authors: Servicio de Dermatología. Hospital Universitario Donostia, San Sebastián, España. Electronic address: ajaka@aedv.es.
authors: A
authors: A
authors: Jaka
authors: Laboratorio de Ingeniería tisular, Instituto Biodonostia, Hospital Universitario Donostia, San Sebastián, España.
authors: A
authors: A
authors: Gutiérrez-Rivera
authors: Servicio de Dermatología. Hospital Universitario Donostia, San Sebastián, España.
authors: A
authors: A
authors: López-Pestaña
authors: Servicio de Dermatología. Hospital Universitario Donostia, San Sebastián, España.
authors: E
authors: E
authors: del Alcázar
authors: Servicio de Dermatología. Hospital Universitario Donostia, San Sebastián, España.
authors: J
authors: J
authors: Zubizarreta
authors: Servicio de Dermatología. Hospital Universitario Donostia, San Sebastián, España.
authors: S
authors: S
authors: Vildosola
authors: Servicio de Dermatología. Hospital Universitario Donostia, San Sebastián, España.
authors: M A
authors: MA
authors: Arregui
authors: Unidad de Metodología, Instituto Biodonostia, Hospital Universitario Donostia, San Sebastián, España.
authors: C
authors: C
authors: Sarasqueta
authors: Servicio de Anatomía Patológica, Hospital Universitario Donostia, San Sebastián, España.
authors: C
authors: C
authors: Lobo
authors: Servicio de Dermatología. Hospital Universitario Donostia, San Sebastián, España.
authors: A
authors: A
authors: Tuneu
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000556:secondary; D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000982:Antipruritics / Q000627:therapeutic use; D000068818:Cetuximab / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy; D003879:Dermatologic Agents / Q000627:therapeutic use*; D003875:Drug Eruptions / Q000188:drug therapy* / Q000209:etiology; D004359:Drug Therapy, Combination; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000037:antagonists & inhibitors; D000077544:Panitumumab; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D017444:Skin Diseases, Papulosquamous / Q000139:chemically induced* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000982:Antipruritics; D003879:Dermatologic Agents; D009363:Neoplasm Proteins; D047428:Protein Kinase Inhibitors; D000077544:Panitumumab; C512478:EGFR protein, human; D066246:ErbB Receptors; D000068818:Cetuximab
keywords: Adverse drug reaction; Anticuerpos monoclonales (cetuximab, panitumumab); Clinical markers; Epidermal growth factor inhibitors; Erupción cutánea; Inhibidores del factor de crecimiento epidérmico; Marcadores clínicos; Monoclonal antibodies (cetuximab, panitumumab); Rash; Reacción adversa medicamentosa; Respuesta tumoral; Tumor response