title: Cutaneous toxicity from epidermal growth factor receptor inhibitors: would a subcutaneous desensitization be helpful? Case report.
abstract: OBJECTIVE
  Cetuximab and panitumumab are monoclonal antibody inhibitors that bind the epidermal growth factor receptor (EGFR) currently used in the treatment of metastatic colorectal cancer. The main adverse event related to EGFR inhibitors (EGFR-Is) is cutaneous toxicity, which can cause dosage reduction and interruption of treatment. State-of-the-art management of skin toxicity associated with EGFR-Is therapy involves the topical administration of corticosteroids and oral antibiotics, but is not completely effective in the management of toxicity. Subcutaneous desensitization with increasing concentrations of monoclonal antibodies can induce a tolerance to drug administration and reduce cutaneous adverse effects. To our knowledge, this is the first case in which a reduction or a disappearance of skin toxicity caused by EGFR-Is through subcutaneous desensitization has been achieved.
  
  
  METHODS
  We present cases of 2 Caucasian patients with adenocarcinoma of the colon treated with EGFR-Is who developed severe cutaneous toxicity. A 73-year-old man presented grade 4 skin toxicity of the face and grade 3 skin toxicity of the trunk during treatment with cetuximab. A 68-year-old woman developed G2 rash on the face after the first administration of cetuximab. These patients underwent subcutaneous desensitization with increasing concentrations of EGFR-Is. After this procedure, patients restarted therapy at the optimal dosage with reduction or disappearance of skin toxicity.
  
  
  CONCLUSIONS
  These cases suggest that by giving rising doses of antibody it is possible to obtain desensitization able to prevent severe cutaneous adverse events in patients treated with EGFR-Is.
authors: Medical Oncology and Internal Medicine, Policlinico San Marco - Istituti Ospedalieri Bergamaschi, Osio Sotto (Bergamo) - Italy.
authors: Andrea
authors: A
authors: D'Alessio
authors: Medical Oncology and Internal Medicine, Policlinico San Marco - Istituti Ospedalieri Bergamaschi, Osio Sotto (Bergamo) - Italy.
authors: Sara
authors: S
authors: Cecchini
authors: Medical Oncology and Internal Medicine, Policlinico San Marco - Istituti Ospedalieri Bergamaschi, Osio Sotto (Bergamo) - Italy.
authors: Daniela
authors: D
authors: Di Mauro
authors: Medical Oncology and Internal Medicine, Policlinico San Marco - Istituti Ospedalieri Bergamaschi, Osio Sotto (Bergamo) - Italy.
authors: Luca
authors: L
authors: Geroli
authors: Medical Oncology and Internal Medicine, Policlinico San Marco - Istituti Ospedalieri Bergamaschi, Osio Sotto (Bergamo) - Italy.
authors: Simonetta
authors: S
authors: Villa
authors: Medical Oncology, Policlinico San Pietro - Istituti Ospedalieri Bergamaschi, Osio Sotto (Bergamo) - Italy.
authors: Antonello
authors: A
authors: Quadri
authors: Medical Oncology and Internal Medicine, Policlinico San Marco - Istituti Ospedalieri Bergamaschi, Osio Sotto (Bergamo) - Italy.
authors: Davide
authors: D
authors: Resta
authors: Medical Oncology and Internal Medicine, Policlinico San Marco - Istituti Ospedalieri Bergamaschi, Osio Sotto (Bergamo) - Italy.
authors: Carmelo
authors: C
authors: Fortugno
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000150:complications / Q000188:drug therapy; D003888:Desensitization, Immunologic; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D008297:Male; D012871:Skin Diseases / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D066246:ErbB Receptors