Not just another rash: management of incontinence-associated dermatitis

2016 ◽  
Vol 21 (9) ◽  
pp. 434-440 ◽  
Author(s):  
Drew Payne
Keyword(s):  
Rash Management

Management of rash to erlotinib (E) and cetuximab (C): Results from the SERIES (Skin and Eye Reactions to Inhibitors of EGFR and kinaseS) clinic algorithm

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19556-19556
Author(s):  
N. V. Martin ◽  
V. Pacifico ◽  
S. E. Lai ◽  
A. Rademaker ◽  
S. Ortiz ◽  
...  
Keyword(s):  
Growth Factor Receptor ◽  
Calcineurin Inhibitors ◽  
Complete Response ◽  
Dose Modification ◽  
Management Algorithm ◽  
Topical Calcineurin Inhibitors ◽  
Best Response ◽  
Epidermal Growth ◽  
Intervention Trials ◽  
Rash Management

19556 Background: Rash develops in approximately 90% of patients (pts) treated with epidermal growth factor receptor inhibitors (EGFRIs) E and C, leading to significant physical/psychosocial discomfort and inconsistent therapy. This study characterizes outcomes of a rash management algorithm developed in the multidisciplinary dermatology-oncology SERIES clinic. Methods: Retrospective chart analysis was performed of pts with E and C rashes (n=45) who were treated with: oral tetracyclines (doxycycline or minocycline) bid and topical calcineurin inhibitors (pimecrolimus/ tacrolimus) or corticosteroids bid. After a baseline visit, pts were assessed at 2–4 week intervals and CTC graded (G). Management data, skin biopsies and photographs were evaluated. Response was defined as: Complete Response (CR) = severity decrease (decr) by 2G, Partial Response (PR) = 1G decr, Stable Disease (SD) = no G change, and Progressive Disease (PD) = increase by = 1G. Best response (BR) was defined as the patient’s best rash outcome at any point in time. Results: 43 out of 45 pts had evaluable data. Of 27 women and 16 men, mean age = 60 yrs (range 34–88), 60% received E and 40% C. For BR, 51% of patients had a CR, 42% had PR, 7% had SD, and 0% had PD. Age was related to BR (p=0.036), with median ages (in years) of 66, 57.5 and 48 for 22, 18 and 3 pts with CR, PR and SD respectively. BR was related to grade (p=0.045), with CR in 69% of G1 pts, 35% in G2 pts, and 54% in G3 pts. BR was not related to E or C (p=0.40). Dose modification was required in 8% (E) and 22% (C) and dose discontinuation in 0% (E) and 17% (C) pts. Conclusions: SERIES algorithm rash management demonstrates that combined oral tetracyclines, topical calcineurin inhibitors and corticosteroids result in improvement in a majority of subjects. The greater rate of dose modification/discontinuation with C supports the need for proactive/early intervention. Trials are underway to evaluate prophylactic therapies against rash to EGFRIs. No significant financial relationships to disclose.

Treatment patterns and outcomes of acneiform skin eruptions from anti-epidermal growth factor receptor (EGFR) therapies for metastatic colorectal cancer (mCRC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19547-e19547
Author(s):  
Bogdan Dascalu ◽  
Hagen F. Kennecke ◽  
Howard John Lim ◽  
Winson Y. Cheung
Keyword(s):  
Overall Survival ◽  
Prophylactic Treatment ◽  
Cox Regression ◽  
Growth Factor Receptor ◽  
Median Number ◽  
Treatment Patterns ◽  
Reactive Groups ◽  
Epidermal Growth ◽  
Number Of Treatment ◽  
Rash Management

e19547 Background: Use of anti-EGFR therapies, such as cetuximab (Cmab) and panitumumab (Pmab), is associated with acneiform eruptions. Because research suggests a correlation between rash severity and outcomes in unselected patients, concerns remain that prophylactic treatment of rash may interfere with anti-tumor activities of these drugs. Our aims were to 1) characterize the treatment patterns for rash due to Cmab and Pmab and 2) evaluate if a prophylactic vs reactive approach to rash management modifies outcomes. Methods: All patients diagnosed with wild-type K-ras mCRC from July 2009 to June 2011 in British Columbia, Canada and prescribed either Cmab or Pmab were reviewed to describe patterns of prophylactic (before rash) and reactive (after rash) use of antibiotics and steroid creams. Using Cox regression, the relationship between rash management and overall survival was characterized. Results: In total, 119 patients were analyzed: median age at diagnosis was 63 years, 61% were men, 34% received Cmab and 66% Pmab, and median number of anti-EGFR treatment was 9 cycles. Rash occurred in over 90% of patients. Among them, reactive was favored over prophylactic treatment (66 vs 34%). Older patients (60+ years) and those with ECOG 0/1 were more likely to receive prophylactic creams (44 vs 20%, p=0.01) and antibiotics (62 vs 12%, p=0.01), respectively. There were no further differences in rash management based on other patient or tumor characteristics (all p>0.05). Median OS was 7.0 months. The number of treatment cycles and overall survival were similar in both prophylactic and reactive groups (both p>0.05). In Cox regression, ECOG 2+ correlated with worse survival than ECOG 0/1 (HR for death 5.25 95% CI 2.01- 9.23, p<0.01). However, survival outcomes were statistically similar between patients prescribed antibiotics prophylactically vs. reactively (HR=1.10, 95% CI 0.43-2.80, p=0.85) and between patients given steroid creams prophylactically vs. reactively (HR=2.00, 95% CI 0.58-6.92, p=0.27). Conclusions: Prophylactic treatment of anti-EGFR related rash is associated with similar outcomes as compared to reactive rash treatment in mCRC patients.

HER1/EGFR Inhibitor‐Associated Rash: Future Directions for Management and Investigation Outcomes from the HER1/EGFR Inhibitor Rash Management Forum

2005 ◽  
Vol 10 (5) ◽  
pp. 345-356 ◽  
Author(s):  
Román Pérez‐Soler ◽  
Jean Pierre Delord ◽  
Allan Halpern ◽  
Karen Kelly ◽  
James Krueger ◽  
...  
Keyword(s):  
Egfr Inhibitor ◽  
Future Directions ◽  
Management Forum ◽  
Rash Management

Treatment patterns and outcomes of acneiform eruptions from anti-epidermal growth factor receptor (EGFR) therapies for metastatic colorectal cancer (MCRC).

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 668-668
Author(s):  
Bogdan Dascalu ◽  
Hagen F. Kennecke ◽  
Howard John Lim ◽  
Winson Y. Cheung
Keyword(s):  
Overall Survival ◽  
Prophylactic Treatment ◽  
Cox Regression ◽  
Growth Factor Receptor ◽  
Median Number ◽  
Treatment Patterns ◽  
Wild Type ◽  
Type K ◽  
Number Of Treatment ◽  
Rash Management

668 Background: Use of anti-EGFR therapies, such as cetuximab (cmab) and panitumumab (pmab), is associated with acneiform eruptions. Because prior research suggests a possible correlation between rash severity and outcomes in unselected patients, concerns remain that prophylactic treatment of rash may interfere with anti-tumor activities of these drugs. Our aims were to: 1) characterize the treatment patterns for rashes due to cmab and pmab; and 2) evaluate if a prophylactic vs. reactive approach to rash management modifies outcomes. Methods: All patients diagnosed with wild-type K-ras MCRC from July 2009 to June 2011 in British Columbia, Canada and prescribed either cmab or pmab were identified. We conducted a detailed retrospective review to describe prophylactic (before rash) and reactive (after rash) use of antibiotics and steroid creams. Using Cox regression, the relationship between rash management and overall survival was characterized. Results: In total, 78 eligible patients were analyzed: median age was 62 years, 65% were male, 27% received cmab and 73% pmab, and median number of anti-EGFR treatment was 9 cycles. Rash occurred in 88% of patients. Among them, reactive treatment was favored over prophylactic treatment (74% vs. 26%). There were no differences in rash management based on any patient or tumor characteristics (all p>0.05). Median overall survival was 7.2 months. The number of treatment cycles and overall survival were similar in both prophylactic and reactive groups. In Cox regression, ECOG 2+ correlated with worse overall survival (HR for death 5.95, 95% CI 1.68- 21.13). However, outcomes were statistically similar between patients prescribed antibiotics prophylactically vs. reactively (HR=1.47, 95% CI 0.37-5.90) and between patients given steroid creams prophylactically vs. reactively (HR=0.75, 95% CI 0.11-4.88). Conclusions: Prophylactic treatment of anti-EGFR related rash is associated with similar outcomes as reactive rash treatment in wild-type K-ras MCRC patients. Because rash can lead to decreased quality of life, pre-emptive skin treatment represents a reasonable strategy for patients on anti-EGFR therapies.

A phase I study of lapatinib (LPT) and cetuximab (CTX) in patients with CTX-sensitive solid tumors.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 2590-2590
Author(s):  
John F. Deeken ◽  
Hongkun Wang ◽  
Jimmy J. Hwang ◽  
John Marshall ◽  
Deepa Suresh Subramaniam ◽  
...  
Keyword(s):  
Phase I ◽  
Head And Neck ◽  
Kinase Inhibitor ◽  
Acquired Resistance ◽  
Maximum Tolerated Dose ◽  
Clinical Activity ◽  
Preclinical Research ◽  
Oncogenic Pathways ◽  
Pathway Activation ◽  
Rash Management

2590 Background: Preclinical research has shown that one mechanism of acquired resistance to CTX is via EGFR-ErbB2 heterodimerization, which can reactivate oncogenic pathways. LPT is a dual EGFR and ErbB2 intracellular tyrosine kinase inhibitor. A phase I translational clinical study was performed to determine the maximum tolerated dose (MTD), dose limiting toxicities (DLTs), and clinical activity of CTX and LPT in patients with EGFR-driven solid tumor malignancies that can be treated with CTX. Methods: Patients (Pts) were enrolled in a 3+3 dose escalation trial. Prior CTX therapy was allowed. CTX was given at 400mg/m2 on Cycle 1, Day 1 (C1D1), then 250 mg/m2 weekly. LPT dose levels (DL) were (1) 750mg, (2) 1000mg, and (3) 1250mg orally daily. Rash management included daily sunblock, steroid cream, and doxycycline. Cycle length was 21 days, and patients were assessed for toxicity through the end of C2, and for efficacy after every 2 cycles. Fresh tumor biopsies were obtained at baseline and at the end of C1 to compare EGFR and ErbB2 expression levels and EGFR related pathway activation. DNA from blood samples was analyzed for pharmacogenetic (PGx) variations and correlations with toxicity and pharmacokinetics (PK). Results: Between October, 2010 to January 2012, 13 pts were enrolled, with colon (4), lung (3), head and neck (3), and anal cancers (3); 10 were evaluable for toxicity. Treatment-related toxicities of any grade included: rash (67%), diarrhea (42%), fatigue (33%), nausea/vomiting (17%), and dehydration (8%). DLTs included G3 rash in 1 of 6 pts on DL1, and G3 diarrhea despite optimal therapy in 1 of 4 pts on DL2. Enrollment to DL2 continues. Of 7 pts evaluable for response, 1 had an uPR, 3 had SD, including 1 with SD of ≥4 cycles, and 3 had DP. Both patients with uPR and prolonged SD were treated on DL1. Tumor EGFR-ErbB2 and EGFR pathway phosphorylation analyses and PGx results will be presented. Conclusions: The combination of CTX and LPT is well tolerated with expected toxicities. Efficacy was seen even on DL 1. Phase II clinical studies in CTX-sensitive diseases such as colon and head and neck cancer are planned.

Vitamin K1 cream in the management of skin rash during anti-EGFR monoclonal antibody (mAb) treatment in patients with metastatic cancer: First analysis of an observational Italian study.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 594-594 ◽  
Author(s):  
C. Pinto ◽  
C. Barone ◽  
A. Martoni ◽  
P. Di Tullio ◽  
A. Orlandi ◽  
...  
Keyword(s):  
Skin Rash ◽  
Metastatic Cancer ◽  
Symptom Control ◽  
Skin Toxicity ◽  
Vitamin K1 ◽  
Treatment Benefit ◽  
Primary Tumor Site ◽  
Cutaneous Toxicity ◽  
Rash Management ◽  
The Impact

594 Background: Cutaneous toxicity, and especially skin rash, is a predictable side- effect of anti-EGFR mAb therapy. Preclinical studies have shown that vitamin K1 reactivated EGFR-mediated signal transduction after inhibition via EGFR receptor antagonists. The aim of this study was to evaluate the impact of vitamin K1 cream in skin rash management. Methods: In two Italian Oncology Centers sequential pts at the first therapy with cetuximab/panitumumab for metastatic cancer were treated with vitamin K1 cream at the first onset of grade ≥2 skin rash. Topical treatment with vitamin K1 (phytomenadione 0.1%) cream twice/die was administered continuously until the end of anti-EGFR treatment. Skin toxicity, according to NCI-CTC v3.0 grading system, was clinically evaluated every week and in a standardized way, taking pictures of 5 different body areas. Treatment benefit was evaluated according to symptom reduction and compliance to therapy. Results: From February to September 2010, 33 pts, 22M (66.6%) and 11F (33.4%), median age 63 years (range 27-79), were evaluated. The primary tumor site was 3 (9.1%) esophagus/stomach, 28 (84.8%) colon-rectum, 2 (6.1%) head-neck. Eighteen (54.5%) pts were treated as first-line and 15 (45.5%) were pretreated. The regimen contained cetuximab in 26 (78.7%) pts and panitumumab in 7 (21.3%). The combination regimens were platinum compounds-based in 23 (69.6%) pts, and irinotecan-based in 6 (18.2%); panitumumab was administered in monotherapy in 4 (12.2%) pts. The median time of vitamin K1 cream treatment was 24 weeks (range 6-28); the oral tetracyclines therapy was associated in 13 (39.4%) pts. The decrease in skin rash to grade 1-0 was observed in 12 (36.4%) pts, and 13 (39.4%) pts showed unchanged grade 2. The increase to grade 3 in skin rash was observed in 8 (24.2%) pts. Good skin rash symptom control was obtained in 69.2% of pts. Cetuximab/panitumumab dose reduction and treatment delays was required in 9 (27.3%) pts. Conclusions: These preliminary results suggest a favorable impact of vitamin K1 cream in skin rash management, which should be considered in a future clinical trial. No significant financial relationships to disclose.

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