Predictive Value of Cetuximab-Induced Skin Toxicity in Recurrent or Metastatic Squamous Cell Carcinoma of the Head and NECK
Predictive Value of Cetuximab-Induced Skin Toxicity in Recurrent or Metastatic Squamous Cell Carcinoma of the Head and NECK
复制标题
DOI：
10.3389/fonc.2018.00616
复制
发表时间：
2018-12-13
影响因子：
4.7
通讯作者：
Yamaguchi, Masakazu
中科院分区：
文献类型：
--
作者：
Uozumi, Shinya;Enokida, Tomohiro;Yamaguchi, Masakazu
背景：皮肤毒性是西妥昔单抗（Cmab）治疗过程中常见的不良事件。然而，很少有报道调查的皮肤毒性和疗效的Cmab在复发或转移性鳞状细胞癌的头颈部（R/M SCCHN）的患者之间的相关性。方法：我们回顾性分析了112 R/M SCCHN患者接受姑息化疗与Cmab。主要合格性标准包括口腔、下咽、鼻咽、口咽或喉的原发性疾病;既往无EGFR导向治疗史;接受Cmab联合化疗作为复发性或转移性疾病的一线治疗;随访超过90天。我们分析了首次发生的时间和最高级别皮肤毒性的时间，其预测值与治疗efficacy.Results：经过中位随访393天（范围109-1501天），105（94%）和20（18%）例患者有皮肤毒性的任何等级和3级，分别。其中，8例患者在治疗开始后90天内发生3级痤疮样皮疹、皮疹或甲沟炎（“早期皮肤毒性”）改善了无进展生存期（PFS）（对数秩检验，P = 0.045; 2年PFS，25.0 vs. 2.9%）和总生存期（OS）（对数秩检验，P = 0.023，2年OS，50.0 vs. 14.4%）。与无早期皮肤毒性的患者相比，有更大比例的患者可以继续接受Cmab维持治疗（88% vs. 44%，P = 0.021）。多变量分析确定早期皮肤毒性是更好的PFS的独立预测因素（风险比[HR] = 0.363，95%置信区间[CI] 0.142-0.924，P = 0.034）和OS HR = 0.187，95% CI：0.045-0.781，P = 0.022。结论：在90 d内发生3级CmAb皮肤毒性与R/M SCCHN患者的生存率相关。因此，有效的皮疹管理似乎是实现Cmab治疗获益的必要条件。
Background: Skin toxicity is a common adverse event during cetuximab (Cmab) treatment. However, few reports have investigated the correlation between skin toxicity and the efficacy of Cmab in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN).Methods: We retrospectively reviewed 112 R/M SCCHN patients who received palliative chemotherapy with Cmab. Main eligibility criteria included primary disease in the oral cavity, hypopharynx, nasopharynx, oropharynx, or larynx; no prior history of EGFR-directed therapy; receipt of Cmab plus chemotherapy as first-line therapy for recurrent or metastatic disease; and follow-up for more than 90 days. We analyzed the time to first occurrence and time of maximum grade skin toxicity, and its predictive value with regard to treatment efficacy.Results: After a median follow-up of 393 days (range 109-1501 days), 105 (94%) and 20 (18%) patients had skin toxicity of any grade and grade 3, respectively. Among them, 8 patients with grade 3 acneiform rash, skin rash, or paronychia within 90 days after treatment initiation ("early skin toxicity") had improved progression-free survival (PFS) (log-rank test, P = 0.045; 2-year PFS, 25.0 vs. 2.9%) and overall survival (OS) (log-rank test, P = 0.023, 2-year OS, 50.0 vs. 14.4%) compared with those with < grade 3 toxicity. A greater proportion of patients with early skin toxicity than patients without this toxicity could proceed with Cmab maintenance (88 vs. 44%, P = 0.021). Multivariate analysis identified early skin toxicity as an independent predictor of better PFS (hazard ratio [HR] = 0.363, 95% confidence interval [CI] 0.142-0.924, P = 0.034) and OS (HR = 0.187, 95% CI: 0.045-0.781, P = 0.022).Conclusion: Grade 3 Cmab-induced skin toxicity within 90 days was associated with better survival in R/M SCCHN. Effective rash management therefore seems necessary to realize the benefit of Cmab treatment.