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• W2170765285 abstract "To the Editor: Over the past 2 decades, research in cancer biology has led to pharmacologic agents targeting the epidermal growth factor receptor (EGFR). EGFR is integral in the proliferation of epithelial cell derived tumors, and overexpression of EGFR is common among adenocarcinomas and tumors with squamous cell histology.1Herbst R.S. Review of epidermal growth factor receptor biology.Int J Radiat Oncol Biol Phys. 2004; 59: 21-26Abstract Full Text Full Text PDF PubMed Scopus (979) Google Scholar The appearance of an acneiform eruption is the most common adverse event associated with EGFR inhibitors,2Gutzmer R. Becker J.C. Enk A. Garbe C. Hauschild A. Leverkus M. et al.Management of cutaneous side effects of EGFR inhibitors: recommendations from a German expert panel for the primary treating physician.J Dtsch Dermatol Ges. 2011; 9: 195-203PubMed Google Scholar and this rash has proven to be a positive sign associated with increased tumor response and overall survival.3Perez-Soler R. Saltz L. Cutaneous adverse effects with HER1/EGFR-targeted agents: is there a silver lining?.J Clin Oncol. 2005; 23: 5235-5246Crossref PubMed Scopus (445) Google Scholar, 4Bachet J.B. Peuvrel L. Bachmeyer C. Reguiai Z. Gourraud P.A. Bouche O. et al.Folliculitis induced by EGFR inhibitors, preventive and curative efficacy of tetracyclines in the management and incidence rates according to the type of EGFR inhibitor administered: a systematic literature review.Oncologist. 2012; 17: 555-568Crossref PubMed Scopus (37) Google Scholar Effective treatment of these eruptions is important to allow for continued use of EGFR inhibitors, but a significant number of patients do not respond to traditional therapy with topical corticosteroids and oral antibiotics. We report our experience treating severe or refractory EGFR inhibitor associated eruptions with isotretinoin. A retrospective analysis of patients enrolled in an Institutional Review Board-approved chemotherapy drug rash database was performed. A total of 203 charts from January 2008 to August 2012 were reviewed. Of 139 patients receiving EGFR inhibitor therapy, 11 elected to initiate treatment with isotretinoin. Dermatology and oncology electronic records, as well as clinical photographs recorded during the course of treatment with isotretinoin, were reviewed to evaluate rash improvement. Eight of the 11 patients showed at least moderate response to isotretinoin. In 4 of these 8 patients, the rash completely cleared and they were able to wean off isotretinoin (Fig 1). The other 4 patients experienced improvement in rash severity without complete clearance. Only 1 patient's rash worsened despite treatment. In 2 patients, responses to isotretinoin could not be assessed because medication was discontinued before formal assessment at follow-up. Reported side effects, including xerosis of the skin and lips, epistaxis, photosensitivity, and impaired healing, were consistent with the well-reported profile of isotretinoin. Isotretinoin was generally well tolerated, but severe xerosis prevented 1 patient from continuing treatment beyond 1 month. Whereas some reviews have highlighted the importance of starting oral tetracyclines prophylactically,4Bachet J.B. Peuvrel L. Bachmeyer C. Reguiai Z. Gourraud P.A. Bouche O. et al.Folliculitis induced by EGFR inhibitors, preventive and curative efficacy of tetracyclines in the management and incidence rates according to the type of EGFR inhibitor administered: a systematic literature review.Oncologist. 2012; 17: 555-568Crossref PubMed Scopus (37) Google Scholar no randomized trials and only a few cases have been reported in the literature regarding the use of oral retinoids in the treatment of EGFR inhibitor-related acneiform eruptions. Our experience supports the use of isotretinoin for the treatment of these eruptions. We find that most patients who respond to isotretinoin do so within the first 1 or 2 months, and patients who continue on isotretinoin long-term tolerate the medication well with minimal side effects and consistent suppression of the acneiform eruption. Extended use of isotretinoin is easily manageable in that it has no known interaction with EGFR inhibitors and few interactions with other medications commonly prescribed for oncology patients. Routine laboratory testing, including fasting lipid panel and liver function tests, should be performed periodically during treatment with isotretinoin. Patients with EGFR inhibitor-related eruptions refractory to traditional therapy should be treated with isotretinoin to permit continuation of their chemotherapy treatment." @default.
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• W2170765285 date "2013-10-01" @default.
• W2170765285 modified "2023-09-25" @default.
• W2170765285 title "Isotretinoin for high-grade or refractory epidermal growth factor receptor inhibitor-related acneiform papulopustular eruptions" @default.
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• W2170765285 doi "https://doi.org/10.1016/j.jaad.2013.05.032" @default.
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