Molinari, E., De Quatrebarbes, J., Andre, T., & Aractingi, S. (2005). Cetuximab-induced acne. Dermatology, 211, 330–333.

To evaluate the effectiveness of systemic antibiotic treatments (oral doxycycline) and local treatment for skin rash in patients receiving cetuximab.

Patients were prospectively evaluated by dermatologists from two phase 2 trials between October 2003 and May 2004. Dermatologists determined they would treat four patients with oral doxycycline; in three of those patients, a topical treatment (retinoid) was given as well. Other patients were treated with benzoyl peroxide (n = 1) or fusidic acid (n = 1).

• The study reported on a sample of 13 patients with metastatic colorectal cancer who were receiving cetuximab once per week (400 mg/m² on week 1 and 250 mg/m² thereafter).
• The cetuximab treatment was associated with oxaliplatin, 5-fluorouracil, and fusidic acid, or irinotecan.

Service de Dermatologie et Service d’Oncologie, Hôpital Tenon, in Paris, France

This was a prospective trial.

Rash intensity was graded as mild, moderate, or severe.

• Eleven patients treated with cetuximab (85%) developed skin lesions.
• The six treated patients responded to classical modalities of doxycycline (n = 4), benzoyl peroxide (n = 1), and fusidic acid (n = 1). Skin lesions resolved in four weeks.
• Five patients were not treated because the acneform rash was mild. In those patients, the rash resolved spontaneously, although cetuximab was continued at the same dose.

Antibiotic treatments (oral doxycycline) and local treatments given to six patients receiving cetuximab were effective in resolving skin lesions.

• This was a very small, nonrandomized trial.
• The description of the measurement tool or method used to grade rash symptoms was inadequate, with no reliability and validity.
• Treatment was determined by the dermatologist.
• A combination of interventions was used; therefore, determining the effectiveness of the individual interventions is difficult.