NCCN Task Force Report: Management of Dermatologic and Other Toxicities Associated With EGFR Inhibition in Patients With Cancer

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This NCCN Task Force Report describes the management of dermatologic and ocular toxicities that occur in patients treated with epidermal growth factor receptor (EGFR) inhibitors. Task force members are from NCCN member institutions and include oncologists, dermatologists, an ophthalmologist, and a mid-level oncology provider. This report describes commonly used therapies that the task force agreed are appropriate standards of care for dermatologic and ophthalmologic toxicities associated with EGFR inhibitors, which generally are supported only by anecdotal evidence. Few recommendations are evidence based; however, some commonly used therapies have data supporting their use. Conclusions from completed clinical trials are generally limited by the small numbers of patients enrolled. The information in this report is based on available published data on treating toxicities associated with EGFR inhibitors, data from treatment of clinically similar toxicities from different etiologies, and expert opinion among the NCCN Task Force members.

  • 1

    Mendelsohn J. Targeting the epidermal growth factor receptor for cancer therapy. J Clin Oncol 2002;20:1s13s.

  • 2

    Castillo L, Etienne-Grimaldi MC, Fischel JL. Pharmacological background of EGFR targeting. Ann Oncol 2004;15:10071012.

  • 3

    Weber RS, Lustig R, Glisson B. A phase II trial of ZD 1869 for advanced cutaneous squamous cell carcinoma of the head and neck [Abstract]. J Clin Oncol 2007;25(Suppl 1):Abstract 6038.

    • Search Google Scholar
    • Export Citation
  • 4

    Saltz L, Rubin M, Hochster H. Cetuximab (IMC-C225) plus irinotecan (CPT-11) is active in CPT-11-refractory colorectal cancer (CRC) that expresses epidermal growth factor receptor (EGFR) [Abstract]. Proc Am Soc Clin Oncol 2001;20:Abstract 7.

    • Search Google Scholar
    • Export Citation
  • 5

    Cunningham D, Humblet Y, Siena S. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med 2004;351:337345.

    • Search Google Scholar
    • Export Citation
  • 6

    Saltz LB, Meropol NJ, Loehrer PJ Sr. Phase II trial of cetuximab in patients with refractory colorectal cancer that expresses the epidermal growth factor receptor. J Clin Oncol 2004;22:12011208.

    • Search Google Scholar
    • Export Citation
  • 7

    Van Cutsem E, Lang I, D’haens G. KRAS status and efficacy in the first-line treatment of patients with metastatic colorectal cancer (mCRC) treated with FOLFIRI with or without cetuximab: the CRYSTAL experience [Abstract]. J Clin Oncol 2008;26(Suppl 1):Abstract 2.

    • Search Google Scholar
    • Export Citation
  • 8

    Pirker R, Szczesna A, von Pawel J. FLEX: a randomized, multicenter, phase III study of cetuximab in combination with cisplatin/vinorelbine (CV) versus CV alone in the first-line treatment of patients with advanced non-small cell lung cancer (NSCLC) [Abstract]. J Clin Oncol 2008;26(Suppl 1):Abstract 3.

    • Search Google Scholar
    • Export Citation
  • 9

    Bonner JA, Harari PM, Giralt J. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 2006;354:567578.

  • 10

    Vermorken JB, Mesia R, Rivera F. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med 2008;359:11161127.

  • 11

    Van Cutsem E, Peeters M, Siena S. Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol 2007;25:16581664.

    • Search Google Scholar
    • Export Citation
  • 12

    Amado RG, Wolf M, Peeters M. Wild-type KRAS is required for panitumumab efficacy in patients with metastatic colorectal cancer. J Clin Oncol 2008;26:16261634.

    • Search Google Scholar
    • Export Citation
  • 13

    Bokemeyer C, Bondarenko I, Hartmann JT. KRAS status and efficacy of first-line treatment of patients with metastatic colorectal cancer (mCRC) with FOLFOX with or without cetuximab: the OPUS experience [Abstract]. J Clin Oncol 2008;26(Suppl 1): Abstract 4000.

    • Search Google Scholar
    • Export Citation
  • 14

    Riely GJ, Pao W, Pham D. Clinical course of patients with non-small cell lung cancer and epidermal growth factor receptor exon 19 and exon 21 mutations treated with gefitinib or erlotinib. Clin Cancer Res 2006;12(3 Pt 1):839844.

    • Search Google Scholar
    • Export Citation
  • 15

    Moore MJ, Goldstein D, Hamm J. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials group. J Clin Oncol 2007;25:19601966.

    • Search Google Scholar
    • Export Citation
  • 16

    Dudek AZ, Kmak KL, Koopmeiners J, Keshtgarpour M. Skin rash and bronchoalveolar histology correlates with clinical benefit in patients treated with gefitinib as a therapy for previously treated advanced or metastatic non-small cell lung cancer. Lung Cancer 2006;51:8996.

    • Search Google Scholar
    • Export Citation
  • 17

    Chang A, Parikh P, Thongprasert S. Gefitinib (IRESSA) in patients of Asian origin with refractory advanced non-small cell lung cancer: subset analysis from the ISEL study. J Thorac Oncol 2006;1:847855.

    • Search Google Scholar
    • Export Citation
  • 18

    Ryan Q, Ibrahim A, Cohen MH. FDA drug approval summary: lapatinib in combination with capecitabine for previously treated metastatic breast cancer that overexpresses HER-2. Oncologist 2008;13:11141119.

    • Search Google Scholar
    • Export Citation
  • 19

    Cameron D, Casey M, Press M. A phase III randomized comparison of lapatinib plus capecitabine versus capecitabine alone in women with advanced breast cancer that has progressed on trastuzumab: updated efficacy and biomarker analyses. Breast Cancer Res Treat 2008;112:533543.

    • Search Google Scholar
    • Export Citation
  • 20

    Geyer CE, Forster J, Lindquist D. Lapatinib plus capecitabine for HER2-positive advanced breast cancer. N Engl J Med 2006;355:27332743.

  • 21

    Myskowski PL, Halpern AC. Cutaneous adverse reactions to therapeutic monoclonal antibodies for cancer. Curr Allergy Asthma Rep 2008;8:6368.

    • Search Google Scholar
    • Export Citation
  • 22

    Saltz L, Kies M, Abbruzzese JL. The presence and intensity of the cetuximab-induced acne-like rash predicts increased survival in studies across multiple malignancies [Abstract]. Proc Am Soc Clin Oncol 2003;22:Abstract 817.

    • Search Google Scholar
    • Export Citation
  • 23

    Wacker B, Nagrani T, Weinberg J. Correlation between development of rash and efficacy in patients treated with the epidermal growth factor receptor tyrosine kinase inhibitor erlotinib in two large phase III studies. Clin Cancer Res 2007;13:39133921.

    • Search Google Scholar
    • Export Citation
  • 24

    Hecht JR, Patnaik A, Berlin J. Panitumumab monotherapy in patients with previously treated metastatic colorectal cancer. Cancer 2007;110:980988.

    • Search Google Scholar
    • Export Citation
  • 25

    Van Cutsem E, Nowacki M, Lang I. Randomized phase III study of irinotecan and 5-FU/FA with or without cetuximab in the first-line treatment of patients with metastatic colorectal cancer (mCRC): the CRYSTAL trial [Abstract]. J Clin Oncol 2007;25(Suppl 1):Abstract 4000.

    • Search Google Scholar
    • Export Citation
  • 26

    Bonner JA, Harari PM, Giralt J. The relationship of cetauximab-induced rash and survival in patients with head and neck cancer treated with radiotherapy and cetuximab [Abstract]. Int J Radiat Oncol Biol Phys 2005;63:S73.

    • Search Google Scholar
    • Export Citation
  • 27

    Boone SL, Rademaker A, Liu D. Impact and management of skin toxicity associated with anti-epidermal growth factor receptor therapy: survey results. Oncology 2007;72:152159.

    • Search Google Scholar
    • Export Citation
  • 28

    Wagner LI, Lacouture ME. Dermatologic toxicities associated with EGFR inhibitors: the clinical psychologist’s perspective. Impact on health-related quality of life and implications for clinical management of psychological sequelae. Oncology (Williston Park) 2007;21(11 Suppl 5):3436.

    • Search Google Scholar
    • Export Citation
  • 29

    Lacouture ME, Lai SE. The PRIDE (papulopustules and/or paronychia, regulatory abnormalities of hair growth, itching, and dryness due to epidermal growth factor receptor inhibitors) syndrome. Br J Dermatol 2006;155:852854.

    • Search Google Scholar
    • Export Citation
  • 30

    Agero AL, Dusza SW, Benvenuto-Andrade C. Dermatologic side effects associated with the epidermal growth factor receptor inhibitors. J Am Acad Dermatol 2006;55:657670.

    • Search Google Scholar
    • Export Citation
  • 31

    National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Available from: (http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf). Accessed March 16, 2009.

    • Search Google Scholar
    • Export Citation
  • 32

    Herbst RS, Maddox AM, Rothenberg ML. Selective oral epidermal growth factor receptor tyrosine kinase inhibitor ZD1839 is generally well-tolerated and has activity in non–small-cell lung cancer and other solid tumors: results of a phase I trial. J Clin Oncol 2002;20:38153825.

    • Search Google Scholar
    • Export Citation
  • 33

    Witherspoon JN, Wagner L, Rademaker A. Correlation of patient characteristics and NCI-Common Terminology Criteria for Adverse Events (CTCAE) v 3.0 grading with dermatology-related quality of life (QoL) in patients with EGFR inhibitor-induced rash [Abstract]. J Clin Oncol 2008;26(Suppl 1):Abstract 9559.

    • Search Google Scholar
    • Export Citation
  • 34

    Van Cutsem E. Challenges in the use of epidermal growth factor receptor inhibitors in colorectal cancer. Oncologist 2006;11:10101017.

  • 35

    Segaert S, Van Cutsem E. Clinical signs, pathophysiology and management of skin toxicity during therapy with epidermal growth factor receptor inhibitors. Ann Oncol 2005;16:14251433.

    • Search Google Scholar
    • Export Citation
  • 36

    Busam KJ, Capodieci P, Motzer R. Cutaneous side-effects in cancer patients treated with the antiepidermal growth factor receptor antibody C225. Br J Dermatol 2001;144:11691176.

    • Search Google Scholar
    • Export Citation
  • 37

    Yano S, Kondo K, Yamaguchi M. Distribution and function of EGFR in human tissue and the effect of EGFR tyrosine kinase inhibition. Anticancer Res 2003;23:36393650.

    • Search Google Scholar
    • Export Citation
  • 38

    Piepkorn M, Predd H, Underwood R, Cook P. Proliferation-differentiation relationships in the expression of heparin-binding epidermal growth factor-related factors and erbB receptors by normal and psoriatic human keratinocytes. Arch Dermatol Res 2003;295:93101.

    • Search Google Scholar
    • Export Citation
  • 39

    Lacouture ME. Mechanisms of cutaneous toxicities to EGFR inhibitors. Nat Rev Cancer 2006;6:803812.

  • 40

    Albanell J, Rojo F, Averbuch S. Pharmacodynamic studies of the epidermal growth factor receptor inhibitor ZD1839 in skin from cancer patients: histopathologic and molecular consequences of receptor inhibition. J Clin Oncol 2002;20:110124.

    • Search Google Scholar
    • Export Citation
  • 41

    Baselga J, Rischin D, Ranson M. Phase I safety, pharmacokinetic, and pharmacodynamic trial of ZD1839, a selective oral epidermal growth factor receptor tyrosine kinase inhibitor, in patients with five selected solid tumor types. J Clin Oncol 2002;20:42924302.

    • Search Google Scholar
    • Export Citation
  • 42

    Shepherd FA, Rodrigues Pereira J, Ciuleanu T. Erlotinib in previously treated non–small-cell lung cancer. N Engl J Med 2005;353:123132.

  • 43

    Lacouture ME, Laabs SM, Koehler M. Analysis of dermatologic events in patients with cancer treated with lapatinib. Breast Cancer Res Treat 2009;114:485493.

    • Search Google Scholar
    • Export Citation
  • 44

    Moss JE, Burtness B. Cetuximab-associated acneiform eruption. N Engl J Med 2005;353:e17.

  • 45

    Laux I, Jain A, Singh S, Agus DB. Epidermal growth factor receptor dimerization status determines skin toxicity to HER-kinase targeted therapies. Br J Cancer 2006;94:8592.

    • Search Google Scholar
    • Export Citation
  • 46

    El-Abaseri TB, Putta S, Hansen LA. Ultraviolet irradiation induces keratinocyte proliferation and epidermal hyperplasia through the activation of the epidermal growth factor receptor. Carcinogenesis 2006;27:225231.

    • Search Google Scholar
    • Export Citation
  • 47

    Luu M, Lai SE, Patel J. Photosensitive rash due to the epidermal growth factor receptor inhibitor erlotinib. Photodermatol Photoimmunol Photomed 2007;23:4245.

    • Search Google Scholar
    • Export Citation
  • 48

    Lai SE, Minnelly L, O’Keeffe P. Influence of skin color in the development of erlotinib-induced rash: a report from the SERIES clinic [Abstract]. J Clin Oncol 2007;25(Suppl 1):Abstract 9127.

    • Search Google Scholar
    • Export Citation
  • 49

    Gridelli C, Maione P, Amoroso D. Clinical significance and treatment of skin rash from erlotinib in non-small cell lung cancer patients: results of an Experts Panel Meeting. Crit Rev Oncol Hematol 2008;66:155162.

    • Search Google Scholar
    • Export Citation
  • 50

    Edgerly M, Fojo T. Is there room for improvement in adverse event reporting in the era of targeted therapies? J Natl Cancer Inst 2008;100:240242.

    • Search Google Scholar
    • Export Citation
  • 51

    Pérez-Soler R, Delord JP, Halpern A. HER1/EGFR inhibitor-associated rash: future directions for management and investigation outcomes from the HER1/EGFR inhibitor rash management forum. Oncologist 2005;10:345356.

    • Search Google Scholar
    • Export Citation
  • 52

    Fox LP. Nail toxicity associated with epidermal growth factor receptor inhibitor therapy. J Am Acad Dermatol 2007;56:460465.

  • 53

    Lord HK, Junor E, Ironside J. Cetuximab is effective, but more toxic than reported in the Bonner trial. Clin Oncol (R Coll Radiol) 2008;20:96.

  • 54

    Eilers RE, West DP, Ortiz S. Dermatologic infections complicate epidermal growth factor receptor inhibitor (EGFRI) therapy in cancer patients. J Am Acad Dermatol 2009;60(Suppl 3):AB3. Abstract P201.

    • Search Google Scholar
    • Export Citation
  • 55

    Pryor DI, Porceddu SV, Burmeister BH. Enhanced toxicity with concurrent cetuximab and radiotherapy in head and neck cancer. Radiother Oncol 2009;90:172176.

    • Search Google Scholar
    • Export Citation
  • 56

    Vano-Galvan S, de las Heras E, Harto A, Jaen P. Severe cutaneous toxicity during concomitant radiotherapy and cetuximab treatment of head and neck cancer. Eur J Dermatol 2008;18:471472.

    • Search Google Scholar
    • Export Citation
  • 57

    Giro C, Berger B, Bölke E. High rate of severe radiation dermatitis during radiation therapy with concurrent cetuximab in head and neck cancer: results of a survey in EORTC institutes. Radiother Oncol 2009;90:166171.

    • Search Google Scholar
    • Export Citation
  • 58

    Mitra SS, Simcock R. Erlotinib induced skin rash spares skin in previous radiotherapy field. J Clin Oncol 2006;24:e2829.

  • 59

    Acharya J, Lyon C, Bottomley DM. Folliculitis-perifolliculitis related to erlotinib therapy spares previously irradiated skin. J Am Acad Dermatol 2009;60:154157.

    • Search Google Scholar
    • Export Citation
  • 60

    Gerber PA, Enderlein E, Homey B. Radiation-induced prevention of erlotinib-induced skin rash is transient: a new aspect toward the understanding of epidermal growth factor receptor inhibitor associated cutaneous adverse effects. J Clin Oncol 2007;25:46974698; author reply 4698–4699.

    • Search Google Scholar
    • Export Citation
  • 61

    Lacouture ME, Hwang C, Marymont MH, Patel J. Temporal dependence of the effect of radiation on erlotinib-induced skin rash. J Clin Oncol 2007;25:2140; author reply 2141.

    • Search Google Scholar
    • Export Citation
  • 62

    Tejwani A, Wu S, Jia Y. Increased risk of high-grade dermatologic toxicities with radiation plus epidermal growth factor receptor inhibitor therapy. Cancer 2009;115:12861299.

    • Search Google Scholar
    • Export Citation
  • 63

    Budach W, Bölke E, Homey B. Severe cutaneous reaction during radiation therapy with concurrent cetuximab. N Engl J Med 2007;357:514515.

  • 64

    Bölke E, Gerber PA, Lammering G. Development and management of severe cutaneous side effects in head-and-neck cancer patients during concurrent radiotherapy and cetuximab. Strahlenther Onkol 2008;184:105110.

    • Search Google Scholar
    • Export Citation
  • 65

    Bonner JA, Ang K, Budach W. More on severe cutaneous reaction with radiotherapy and cetuximab. N Engl J Med 2007;357:18721873.

  • 66

    Tan AR, Yang X, Hewitt SM. Evaluation of biologic end points and pharmacokinetics in patients with metastatic breast cancer after treatment with erlotinib, an epidermal growth factor receptor tyrosine kinase inhibitor. J Clin Oncol 2004;22:30803090.

    • Search Google Scholar
    • Export Citation
  • 67

    Roé E, Muret M, Marcuello E. Description and management of cutaneous side effects during cetuximab or erlotinib treatments: a prospective study of 30 patients. J Am Acad Derm 2006;55:429437.

    • Search Google Scholar
    • Export Citation
  • 68

    Konheim A, Brebach E, Samuel J. Magnetic resonance imaging of paronychia induced by cetuximab. Clin Exp Dermatol 2009; in press.

  • 69

    Bowler PG, Duerden BI, Armstrong DG. Wound microbiology and associated approaches to wound management. Clin Microbiol Rev 2001;14:244269.

  • 70

    Edwards R, Harding KG. Bacteria and wound healing. Curr Opin Infect Dis 2004;17:9196.

  • 71

    Wysocki AB. Evaluating and managing open skin wounds: colonization versus infection. AACN Clin Issues 2002;13:382397.

  • 72

    Costa DB, Kobayashi S, Schumer ST. Erlotinib-associated alopecia in a lung cancer patient. J Thorac Oncol 2007;2:11361138.

  • 73

    Donovan JC, Ghazarian DM, Shaw JC. Scarring alopecia associated with use of the epidermal growth factor receptor inhibitor gefitinib. Arch Dermatol 2008;144:15241525.

    • Search Google Scholar
    • Export Citation
  • 74

    Graves JE, Jones BF, Lind AC, Heffernan MP. Nonscarring inflammatory alopecia associated with the epidermal growth factor receptor inhibitor gefitinib. J Am Acad Dermatol 2006;55:349353.

    • Search Google Scholar
    • Export Citation
  • 75

    Carser JE, Summers YJ. Trichomegaly of the eyelashes after treatment with erlotinib in non-small cell lung cancer. J Thorac Oncol 2006;1:10401041.

    • Search Google Scholar
    • Export Citation
  • 76

    Braiteh F, Kurzrock R, Johnson FM. Trichomegaly of the eyelashes after lung cancer treatment with the epidermal growth factor receptor inhibitor erlotinib. J Clin Oncol 2008;26:34603462.

    • Search Google Scholar
    • Export Citation
  • 77

    Lane K, Goldstein SM. Erlotinib-associated trichomegaly. Ophthal Plast Reconstr Surg 2007;23:6566.

  • 78

    Liu Z, Carvajal M, Carraway CA. Expression of the receptor tyrosine kinases, epidermal growth factor receptor, ErbB2 and ErbB3 in human ocular surface epithelia. Cornea 2001;20:8185.

    • Search Google Scholar
    • Export Citation
  • 79

    Basti S. Ocular toxicities of epidermal growth factor receptor inhibitors and their management. Cancer Nurs 2007;30(4 Suppl 1):S1016.

  • 80

    Foerster CG, Cursiefen C, Kruse FE. Persisting corneal erosion under cetuximab (Erbitux) treatment (epidermal growth factor receptor antibody). Cornea 2008;27:612614.

    • Search Google Scholar
    • Export Citation
  • 81

    Methvin AB, Gausas RE. Newly recognized ocular side effects of erlotinib. Ophthal Plast Reconstr Surg 2007;23:6365.

  • 82

    Zhang G, Basti S, Jampol LM. Acquired trichomegaly and symptomatic external ocular changes in patients receiving epidermal growth factor receptor inhibitors: case reports and a review of literature. Cornea 2007;26:858860.

    • Search Google Scholar
    • Export Citation
  • 83

    Shah NT, Kris MG, Pao W. Practical management of patients with non–small-cell lung cancer treated with gefitinib. J Clin Oncol 2005;23:165174.

    • Search Google Scholar
    • Export Citation
  • 84

    Fukuoka M, Yano S, Giaccone G. Multi-institutional randomized phase II trial of gefitinib for previously treated patients with advanced non–small-cell lung cancer. J Clin Oncol 2003;21:22372246.

    • Search Google Scholar
    • Export Citation
  • 85

    Segaert S, Van Cutsem E. Clinical management of EGFRI dermatologic toxicities: the European perspective. Oncology (Williston Park) 2007;21(11 Suppl 5):2226.

    • Search Google Scholar
    • Export Citation
  • 86

    Lacouture ME, Cotliar J, Mitchell EP. Clinical management of EGFRI dermatologic toxicities: US perspective. Oncology (Williston Park) 2007;21(11 Suppl 5):1721.

    • Search Google Scholar
    • Export Citation
  • 87

    Yamazaki N, Muro K. Clinical management of EGFRI dermatologic toxicities: the Japanese perspective. Oncology (Williston Park) 2007;21(11 Suppl 5):2728.

    • Search Google Scholar
    • Export Citation
  • 88

    Scope A, Agero AL, Dusza SW. Randomized double-blind trial of prophylactic oral minocycline and topical tazarotene for cetuximab-associated acne-like eruption. J Clin Oncol 2007;25:53905396.

    • Search Google Scholar
    • Export Citation
  • 89

    Fox LP. Pathology and management of dermatologic toxicities associated with anti-EGFR therapy. Oncology (Williston Park) 2006;20(Suppl 2):2634.

    • Search Google Scholar
    • Export Citation
  • 90

    Scope A, Lieb JA, Dusza SW. A prospective randomized trial of topical pimecrolimus for cetuximab-associated acne-like eruption. J Am Acad Dermatol 2009; in press.

    • Search Google Scholar
    • Export Citation
  • 91

    Lynch TJ Jr, Kim ES, Eaby B. Epidermal growth factor receptor inhibitor-associated cutaneous toxicities: an evolving paradigm in clinical management. Oncologist 2007;12:610621.

    • Search Google Scholar
    • Export Citation
  • 92

    Hu JC, Sadeghi P, Pinter-Brown LC. Cutaneous side effects of epidermal growth factor receptor inhibitors: clinical presentation, pathogenesis, and management. J Am Acad Dermatol 2007;56:317326.

    • Search Google Scholar
    • Export Citation
  • 93

    Racca P, Fanchini L, Caliendo V. Efficacy and skin toxicity management with cetuximab in metastatic colorectal cancer: outcomes from an oncologic/dermatologic cooperation. Clin Colorectal Cancer 2008;7:4854.

    • Search Google Scholar
    • Export Citation
  • 94

    Vezzoli P, Marzano AV, Onida F. Cetuximab-induced acneiform eruption and the response to isotretinoin. Acta Derm Venereol 2008;88:8486.

  • 95

    Gutzmer R, Werfel T, Mao R. Successful treatment with oral isotretinoin of acneiform skin lesions associated with cetuximab therapy. Br J Dermatol 2005;153:849851.

    • Search Google Scholar
    • Export Citation
  • 96

    Pomerantz RG, Chirinos RE, Falo LD Jr, Geskin LJ. Acitretin for treatment of EGFR inhibitor-induced cutaneous toxic effects. Arch Dermatol 2008;144:949950.

    • Search Google Scholar
    • Export Citation
  • 97

    Perez-Soler R, Zou Y, Li T. Topical vitamin K3 (Vit K3, Menadione) prevents erlotinib and cetuximab-induced EGFR inhibition in the skin [Abstract]. J Clin Oncol 2006;24(Suppl 1):Abstract 3036.

    • Search Google Scholar
    • Export Citation
  • 98

    Perez-Soler R, Zou Y, Li T, Ling Y. Steroids and immunosuppressive agents potentiate the cytotoxicity of the EGFR inhibitor erlotinib (E) in human skin keratinocytes whereas Vit K3 exerts a protective effect: implications for the management of the skin rash [Abstract]. J Clin Oncol 2007;25(Suppl 1):Abstract 9124.

    • Search Google Scholar
    • Export Citation
  • 99

    Boström A, Lindman H, Swartling C. Potent corticosteroid cream (mometasone furoate) significantly reduces acute radiation dermatitis: results from a double-blind, randomized study. Radiother Oncol 2001;59:257265.

    • Search Google Scholar
    • Export Citation
  • 100

    Bernier J, Bonner J, Vermorken JB. Consensus guidelines for the management of radiation dermatitis and coexisting acne-like rash in patients receiving radiotherapy plus EGFR inhibitors for the treatment of squamous cell carcinoma of the head and neck. Ann Oncol 2008;19:142149.

    • Search Google Scholar
    • Export Citation
  • 101

    Jatoi A, Rowland K, Sloan JA. Tetracycline to prevent epidermal growth factor receptor inhibitor-induced skin rashes: results of a placebo-controlled trial from the North Central Cancer Treatment Group (N03CB). Cancer 2008;113:847853.

    • Search Google Scholar
    • Export Citation
  • 102

    Lacouture ME, Mitchell EP, Shearer H. Impact of pre-emptive skin toxicity (ST) treatment (tx) on panitumumab (pmab)-related skin toxicities and quality of life (QOL) in patients (pts) with metastatic colorectal cancer (mCRC): results from STEPP [Abstract]. ASCO Gastrointestinal Cancers Symposium 2009;Abstract 291.

    • Search Google Scholar
    • Export Citation
  • 103

    Schmuth M, Wimmer MA, Hofer S. Topical corticosteroid therapy for acute radiation dermatitis: a prospective, randomized, double-blind study. Br J Dermatol 2002;146:983991.

    • Search Google Scholar
    • Export Citation
  • 104

    Elliott EA, Wright JR, Swann RS. Phase III trial of an emulsion containing trolamine for the prevention of radiation dermatitis in patients with advanced squamous cell carcinoma of the head and neck: results of Radiation Therapy Oncology Group trial 99-13. J Clin Oncol 2006;24:20922097.

    • Search Google Scholar
    • Export Citation
  • 105

    Pommier P, Gomez F, Sunyach MP. Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol 2004;22:14471453.

    • Search Google Scholar
    • Export Citation
  • 106

    Eaby B, Culkin A, Lacouture ME. An interdisciplinary consensus on managing skin reactions associated with human epidermal growth factor receptor inhibitors. Clin J Oncol Nurs 2008;12:283290.

    • Search Google Scholar
    • Export Citation
  • 107

    Oishi K. Clinical approaches to minimize rash associated with EGFR inhibitors. Oncol Nurs Forum 2008;35:103111.

  • 108

    Shuhaiber JH, Lipnick S, Teresi M. More on Monsel’s solution... Surgery 2005;137:263264.

  • 109

    Jetmore AB, Heryer JW, Conner WE. Monsel’s solution: a kinder, gentler hemostatic. Dis Colon Rectum 1993;36:866867.

  • 110

    Rupp ME, Medcalf SJ, Fey PD. Monsel’s solution: a potential vector for nosocomial infection? Infect Control Hosp Epidemiol 2003;24:142144.

  • 111

    Porzio G, Aielli F, Verna L. Efficacy of pregabalin in the management of cetuximab-related itch. J Pain Symptom Manage 2006;32:397398.

  • 112

    Ehrchen J, Ständer S. Pregabalin in the treatment of chronic pruritus. J Am Acad Dermatol 2008;58(2 Suppl):S3637.

  • 113

    Shu KY, Kindler HL, Medenica M, Lacouture M. Doxycycline for the treatment of paronychia induced by the epidermal growth factor receptor inhibitor cetuximab. Br J Dermatol 2006;154:191192.

    • Search Google Scholar
    • Export Citation
  • 114

    Tosti A, Piraccini BM, Ghetti E, Colombo MD. Topical steroids versus systemic antifungals in the treatment of chronic paronychia: an open, randomized double-blind and double dummy study. J Am Acad Dermatol 2002;47:7376.

    • Search Google Scholar
    • Export Citation
  • 115

    Donovan JC, Ghazarian DM, Shaw JC. Scarring alopecia associated with use of the epidermal growth factor receptor inhibitor gefitinib. Arch Dermatol 2008;144:15241525.

    • Search Google Scholar
    • Export Citation
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