Improved 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 toxicities 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 toxicities, 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) and sorafenib(Drug information on sorafenib) (Nexavar), including hand-foot skin reaction (HFSR), xerosis, rash, and subungual splinter hemorrhages.
On the following pages a number of photographs are provided to depict the various types of dermatologic reactions that may occur in patients receiving these agents.
FIGURE 1  Sensory disturbance (first) stage | FIGURE 2  Pustular (second) stage | FIGURE 3  Papulopustular crust (third) stage | FIGURE 4  Erythematous (fourth) stage |
Papulopustular (Acneiform) Eruption, Phases 1-4 — Treatment of papulopustular eruption from exposure to EGFR inhibitors and multikinase inhibitors consists of a tetracycline(Drug information on tetracycline) antibiotic (tetracycline 500 mg bid, minocycline(Drug information on minocycline) 100 mg qd, or doxycycline(Drug information on doxycycline) 100 mg bid). Topical corticosteroids of medium to low potency have also shown benefit.
FIGURE 5  Eyelash tricho-megaly | FIGURE 6  EGFR inhibitor fissures | FIGURE 7  EGFR inhibitor inflammatory alopecia | FIGURE 8  EGFR inhibitor xerosis |
FIGURE 9  EGFR inhibitor photosensitivity | FIGURE 10  EGFR inhibitor plus radiotherapy radiation dermatitis | FIGURE 11A and 11B  Hand-foot skin reaction 1 and 2) | FIGURE 12  Docetaxel Periarticular thenar erythema with onycholysis (PATEO) syndrome |
FIGURE 13  Pegylated doxorubicin and capecitabine(Drug information on capecitabine) hand-foot syndrome | FIGURE 14  Temsirolimus and everolimus-induced rash: Temsirolimus and evero- limus-induced rash |
SUGGESTED READING
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Lacouture ME, Mitchell EP, Shearer H, et al: A phase II, open-label trial of skin toxicity (ST) evaluation (STEPP) in metastatic colorectal cancer (mCRC) patients (pts) receiving panitumumab (pmab) + FOLFIRI or irinotecan(Drug information on irinotecan)-only chemotherapy (CT as 2nd-line treatment (tx): Interim analysis. J Clin Oncol 28:1351–1357, 2010.
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Scope A, Agero AL, Dusza SW, et al: Randomized double-blind trial of prophylactic oral minocycline and topical tazarotene(Drug information on tazarotene) for cetuximab-associated acne-like eruption. J Clin Oncol 25:5390–5396, 2007.
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