• Mon. Nov 28th, 2022

Early studies observed a correlation between better outcomes and patients who designed dermatologic toxicity early after treatment


Jun 23, 2022

Early studies observed a correlation between better outcomes and patients who designed dermatologic toxicity early after treatment.75,76 Subsequently, numerous other studies (which have been extensively reviewed previously31,48,77C81) also described positive associations between the severity of skin toxicity and outcomes, such as the ORR, OS, PFS, and time to tumor progression, among patients receiving cetuximab or panitumumab.82,83 Association With Quality of Life. 31; retrospective studies, n = 15; reviews, n = 39). Dermatologic toxicity of any grade occurs in most patients who receive anti-EGFR therapy; approximately 10% to 20% of patients experienced grade 3/4 toxicity. The most common dermatologic toxicities include papulopustular/acneiform rash, xerosis, and pruritus; however, nail changes, hair abnormalities, and ocular conditions also occur. Guidance for managing these toxicities includes the use of inexpensive emollient ointments and moisturizers, avoidance of sun exposure, avoidance of irritants, and the use of short showers. Several studies also found that preemptive treatment was more effective than reactive treatment at limiting the incidence and severity of skin toxicity. With appropriate treatment, the dermatologic toxicities associated with anti-EGFR monoclonal antibody therapy can be managed, minimizing patient discomfort and the need for Triptonide therapy interruption and/or discontinuation. Additionally, preemptive treatment can reduce dermatologic toxicity severity, ultimately yielding better quality of life. CRC in the first-, second-, and third-line settings as monotherapies and combined with chemotherapy.4,5,13C16 Determining status and, more recently, status (ie, exon 2, 3, 4, and exons 2, 3, 4), is extremely important in CRC because patients with mutated, constitutively active will not respond to panitumumab or cetuximab therapy.5,14C20 The current guidelines from the National Comprehensive Malignancy Network and European Society of Medical Oncology recommend the use of panitumumab and cetuximab as appropriate options for patients with wild-type mCRC and recommend the use of extended testing for all those patients before receiving Triptonide treatment with these anti-EGFR antibodies.21,22 Treatment with anti-EGFR brokers has been associated with a number of dermatologic toxicities (including skin rash, abnormal hair growth, ocular abnormalities). These toxicities can occur frequently: ~90% of patients will experience skin toxicity of any grade during treatment with panitumumab or cetuximab monotherapy, although most events will be grade 1 or 2 2 in severity2, 23 and rarely life-threatening. In a systematic review of 8998 patients with cancer, no deaths were attributed to dermatologic toxicity.24 However, because these toxicities can result in treatment discontinuation and can potentially affect a patients emotional and physical well-being, their management should be an important focus when administering these brokers.25 Guidance on the management of skin toxicity occurring during treatment with EGFR inhibitors in patients with cancer was reported in 2009 2009.25 Since 2009, the methods for treatment of mCRC with anti-EGFR antibodies have changed because of important developments in the management of such Triptonide skin toxicity and changes in the clinical use of anti-EGFR monoclonal antibodies. Anti-EGFR therapy was initially approved as third-line Sstr1 therapy2,23; however, subsequent approvals for use as first- and second-line therapy and combined with chemotherapy have occurred in the United States, Europe, Canada, and other localities.7,9,26,27 Evidence has also shown that this incidence and severity of dermatologic toxicity can be influenced by the addition of chemotherapy.2,4,5,23,28 New approaches to the management of skin toxicity have been used, such as the introduction of novel therapeutic agents and the use of preemptive treatment approaches based on the regimens evaluated in the STEPP (Skin Toxicity Evaluation Protocol with Panitumumab) and J-STEPP (randomized controlled trial on the skin toxicity of panitumumab in Japanese patients with metastatic colorectal cancer: HGCSG1001 study) randomized studies, which showed that preemptive treatment resulted in a reduced incidence of skin toxicity Triptonide compared with reactive treatment.29,30 Furthermore, new evidence has shown associations between skin toxicity and both Triptonide efficacy outcomes31 and patient quality of life.32,33 Given these changes, an updated report providing information around the management of dermatologic toxicity during treatment with anti-EGFR inhibitors in patients with mCRC would be of significant value. To address this need, we conducted a systematic review of recent data to examine the types and frequencies of dermatologic toxicities associated with anti-EGFR therapies and to explore the management and treatment options for patients with CRC currently used by clinicians. Patients and Methods Search Parameters A search of the National Library of Medicine PubMed database was performed to identify relevant data discussing the management of dermatologic toxicities associated with the use of anti-EGFR therapies in the treatment of mCRC and the association between toxicity and patient outcomes. The lower limit date of the search was set at January 1, 2009, to capture studies reported after the 2009 publication..