Novel cancer therapies have brought about unprecedented improvements in survival along with decreased hematopoietic toxicities, when compared with cytotoxic chemotherapy. Therefore, other components of the cancer experience have come forward, such as supportive care and psychological well-being. Most notably, dermatologic adverse events have gained considerable attention due to their high frequency, appearance in functional and cosmetically sensitive areas, and association with symptoms of pain and pruritus—all of which lead to decreased quality of life and inconsistent dose intensity. In turn, clinical outcome may be affected with dose modifications in response to these untoward events.
Therapies targeting specific pathways or proteins in cancer cells are especially noted for dermatologic events, which affect up to 90% of treated patients. These toxicities are generally a class effect, and will occur with the use of monoclonal antibodies or small-molecule kinase inhibitors with similar targets. Epidermal growth factor receptor (EGFR) inhibitors, ie, erlotinib (Tarceva), cetuximab(Drug information on cetuximab) (Erbitux), and panitumumab (Vectibix), will lead to a papulopustular eruption, xerosis, pruritus, paronychia, alopecia, and hypertrichosis of the face with trichomegaly of the eyelashes. These effects will occur at different times during therapy, and not all patients will develop most toxicities.
In a similar fashion, a number of dermatologic side effects have been associated with the small-molecule multikinase inhibitors sunitinib (Sutent), pazopanib (Votrient), axitinib (Inlyta), and sorafenib(Drug information on sorafenib) (Nexavar), including hand-foot skin reaction (HFSR), xerosis, rash, and subungual splinter hemorrhages. Inhibitors of mTOR, which include everolimus (Afinitor) and temsirolimus (Torisel), may also result in a papulopustular or maculopapular rash in up to 30% of patients, and can be intensely pruritic. The introduction of new agents against melanoma deserves special attention: vemurafenib (Zelboraf) and ipilimumab (Yervoy). Vemurafenib causes a maculopapular rash, HFSR, photosensitivity, hair thinning, and the development of keratoacanthomas in about 20% of patients. Ipilimumab results in pruritus, rash, and loss of skin or hair color.
In this color atlas, the photographs provided depict various types of dermatologic reactions that may occur in patients receiving these agents.
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