Treatment of Epidermal Growth Factor Receptor Antagonist-Induced Skin Rash: Results of a Survey among German Oncologists
Treatment of Epidermal Growth Factor Receptor Antagonist-Induced Skin Rash: Results of a Survey among German Oncologists
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DOI：
10.1159/000277656
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发表时间：
2010-01-01
期刊：
影响因子：
0.3
通讯作者：
Hofheinz, Ralf-Dieter
中科院分区：
文献类型：
--
作者：
Hassel, Jessica C.;Kripp, Melanie;Hofheinz, Ralf-Dieter
背景：皮肤毒性在接受表皮生长因子受体（EGFR）拮抗剂治疗的患者中很常见。这些皮肤反应的分级和管理缺乏标准化。材料与方法：我们通过Internistische Onkologie（AIO）和Dermatologische Onkologie（ADO）工作组，使用通过电子邮件分发的7项问卷在德国肿瘤学家中进行了调查。向肿瘤学家提供了痤疮样皮疹患者的照片和病史，并要求其提供分级和治疗策略的信息。结果：106名医学肿瘤学家和43名皮肤肿瘤学家回答了调查。皮疹评分如下（国家癌症研究所常见毒性标准（NCI-CTC）1/2/3级;%）：10/59/31。22%的受访医学肿瘤学家使用预防性治疗皮疹。在本病例中，91%的患者选择主要使用氢化可的松或抗生素乳膏进行局部治疗，64%的患者选择使用抗生素或异维甲酸进行全身治疗。只有9%的医学肿瘤学家会将患者转介给皮肤科医生。皮肤肿瘤科医生使用更多的局部抗生素（p = 0.006），而较少使用局部类固醇（p = 0.199）。关于全身治疗，皮肤肿瘤学家更常使用异维甲酸（p = 0.002）。此外，皮肤肿瘤学家很少因为皮肤毒性而延迟西妥昔单抗治疗（p = 0.009）。结论：本分析的结果表明，EGFR拮抗剂诱导的皮肤毒性的分级和治疗是非常异质性的。显然，需要更多的随机试验和一个简单可靠的分级系统。
Background: Skin toxicities are frequent in patients receiving epidermal growth factor receptor (EGFR) antagonists. Grading and management of these skin reactions are poorly standardized. Materials and Methods: We conducted a survey among German oncologists using a 7-item questionnaire distributed by e-mail via the working groups Internistische Onkologie (AIO) and Dermatologische Onkologie (ADO). The oncologists were provided with pictures and history of a patient with an acneiform rash and were asked to provide information on grading and treatment strategies. Results: 106 medical oncologists and 43 dermatooncologists responded to the survey. The scoring of the skin rash was indicated as follows (National Cancer Institute common toxicity criteria (NCI-CTC) grades 1/2/3;%): 10/59/31. 22% of the polled medical oncologists use preemptive treatment of skin rash. In the presented case, 91% chose local treatment with mainly hydrocortisone or antibiotic cream, and 64% chose systemic treatment with an antibiotic or isotretinoin. Only 9% of the medical oncologists would have referred the patient to a dermatologist. Dermatooncologists used more local antibiotics (p = 0.006) and rather less local steroids (p = 0.199). With regard to systemic treatment, dermatooncologists more often used isotretinoin (p = 0.002). In addition, dermatooncologists less often delayed cetuximab treatment because of skin toxicity (p = 0.009). Conclusions: The results of the present analysis illustrate that grading and treatment of EGFR antagonist-induced skin toxicities are very heterogeneous. Clearly, more randomized trials and a simple and reliable grading system are warranted.