Korean J Dermatol.  2008 Nov;46(11):1478-1487.

Clinical Features of the Cutaneous Adverse Events Induced by Combination Chemotherapy that Includes Cetuximab (Erbitux(R))

• Chung WK
• Chang SE
• Ryu MH
• Lee MW
• Choi JH
• Moon KC
• Koh JK

Abstract

BACKGROUND
Epidermal growth factor receptor (EGFR) inhibitors are associated with cutaneous adverse events, including papulopustular eruption, xerosis, paronychia, hair abnormality and mucositis. In particular, acneiform eruptions might serve as the visible markers of anti-tumor activity and the therapeutic efficacy of EGFR inhibitors.
OBJECTIVE
Our aims are to investigate the common cutaneous adverse events induced by cetuximab, which is one of the EGFR inhibitors approved by the US Food and Drug Administration, and to analyze whether the presence and severity of papulopustular eruptions have a correlation with the tumor response.
METHODS
We retrospectively reviewed the medical records and clinical photographs of 114 Korean patients who had been treated with cetuximab at Asan Medical Center from September 2004 to March 2007.
Results
Papulopustular eruptions occurred in 100 patients (87.7%) and this usually happened 10 days after starting chemotherapy. There was a tendency that the better the tumor responded to the chemotherapeutic agents including cetuximab, the more severe were the papulopustular eruptions. The papulopustular eruptions prominently improved after the treatment with topical agents such as benzoyl peroxide, metronidazole, clindamycin and retinoid, and with systemic agents such as minocycline and tetracycline, and there was no adverse event induced by this treatment for papulopustular eruptions. Xerosis appeared in 67 patients (58.8%), and there was a tendency that the more severe papulopustular eruptions were, the more frequently xerosis occurred. Paronychia occurred in 8 patients (7.0%).
CONCLUSION
Although the cutaneous adverse events are burdensome to the patients, they might serve as visible markers of the anti-tumor activity and therapeutic efficacy of cetuximab and they can be easily and safely controlled with many topical and systemic agents. Therefore, it is important for dermatologists to properly treat these cutaneous adverse events and to reassure the patient to continue with the cetuximab treatment.

Keyword

Acneiform eruption; Cetuximab; Epidermal growth factor receptor; Erbitux; Papulopustular eruption

MeSH Terms

Acneiform Eruptions
Antibodies, Monoclonal, Humanized
Benzoyl Peroxide
Clindamycin
Drug Therapy, Combination
Hair
Humans
Medical Records
Metronidazole
Minocycline
Mucositis
Paronychia
Receptor, Epidermal Growth Factor
Retrospective Studies
Tetracycline
United States Food and Drug Administration
Cetuximab
Antibodies, Monoclonal, Humanized
Benzoyl Peroxide
Clindamycin
Metronidazole
Minocycline
Receptor, Epidermal Growth Factor
Tetracycline