Dermatologic Infections in Cancer Patients Treated With Epidermal Growth Factor Receptor Inhibitor Therapy
Dermatologic Infections in Cancer Patients Treated With Epidermal Growth Factor Receptor Inhibitor Therapy
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DOI：
10.1093/jnci/djp439
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发表时间：
2010-01-06
影响因子：
10.3
通讯作者：
Lacouture, Mario E.
中科院分区：
文献类型：
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作者：
Eilers, R. E., Jr.;Gandhi, M.;Lacouture, Mario E.
接受表皮生长因子受体抑制剂（EGFRI）治疗的患者经常出现皮肤毒性反应。尽管这些效应对生活质量和EGFRI剂量的影响已经被描述，但它们对身体健康的影响尚未确定。我们调查了EGFR抑制剂皮肤毒性反应并发感染的患病率，采用回顾性病历分析方法，分析了221例在EGFR抑制剂和激酶皮肤和眼睛反应诊所（癌症治疗皮肤毒性反应的转诊诊所）接受治疗的患者。我们回顾了患者病历中记录的细菌培养、活检样本的组织病理学评估和皮肤标本的病毒病原体免疫组织化学染色结果。使用Fisher精确检验检查患者人口统计学和治疗特征与感染发展之间的关联。所有的统计学检验都是双侧的，221例患者中有84例（38%）在皮肤毒性作用部位显示出感染的证据。221例患者中有50例（22.6%）金黄色葡萄球菌培养阳性，12例（5.4%）耐甲氧西林金黄色葡萄球菌培养阳性。较不常见的感染包括单纯疱疹（3.2%）、带状疱疹（1.8%）和皮肤癣菌（10.4%）。脂溢性区域是最常见的感染部位，白细胞减少的患者比没有白细胞减少的患者感染的风险更高（P = 0.005）。人口统计学因素和相关治疗与皮肤感染的发生无关（P >= 0.05）。EGFRIs治疗后出现皮肤毒性反应的患者皮肤感染的患病率较高。最值得注意的是，细菌感染发生在以前受皮肤毒性作用影响的部位，白细胞减少症患者的风险更大。
Patients treated with epidermal growth factor receptor inhibitors (EGFRIs) frequently experience dermatologic toxic effects. Whereas the impact of these effects on quality of life and EGFRI dosing has been described, their impact on physical health has not been ascertained. We examined the prevalence of infections that complicate dermatologic toxic effects of EGFRIs.We used retrospective chart review methods to analyze 221 patients who were treated in the Skin and Eye Reactions to Inhibitors of EGFR and Kinases clinic, a referral clinic for dermatologic toxic effects of cancer therapies. We reviewed results of bacterial cultures, histopathologic assessment of biopsy samples, and immunohistochemical staining of skin specimens for viral pathogens that were recorded in the patients' medical records. Associations between patient demographic and treatment characteristics and the development of infections were examined using the Fisher exact test. All statistical tests were two-sided.Eighty-four (38%) of the 221 patients showed evidence of infection at sites of dermatologic toxic effect. Fifty (22.6%) of the 221 patients had cultures positive for Staphylococcus aureus, and 12 (5.4%) of the 221 patients cultured positive for methicillin-resistant S aureus. Less frequent infections included herpes simplex (3.2%), herpes zoster (1.8%), and dermatophytes (10.4%). The seborrheic region was the most prevalent site of infection, and patients with leukopenia had higher risk for infection than patients who did not have leukopenia (P = .005). Demographic factors and associated treatments were not associated with the occurrence of a dermatologic infection (P >= .05).Patients with dermatologic toxic effects following treatment with EGFRIs have a high prevalence of cutaneous infections. Most notably, bacterial infections developed at sites previously affected by dermatologic toxic effects, with leukopenic patients being at greater risk.