Potthoff, K., Hofheinz, R., Hassel, J.C., Volkenandt, M., Lordick, F., Hartmann, J.T., Karthaus, M., . . . Wollenberg, A. (2011). Interdisciplinary management of EGFR-inhibitor-induced skin reactions: A German expert opinion. Annals of Oncology, 22, 524–535.

To provide interdisciplinary expert recommendations on how to treat patients with skin reactions undergoing anti–epidermal growth factor receptor (EGFR) treatment.

The task force prepared the first manuscript based on the data retrieved. All panel members were then asked to agree on a consensus statement following a period of meetings and discussions.

The search strategy included literature published until April 8, 2010, and data presented during the Annual Meeting of the American Society of Clinical Oncology (ASCO) 2008; the World Congress of Gastrointestinal (GI) Cancer, Barcelona 2008; the European Cancer Organisation–15 Congress 2008; ASCO GI 2009; and ASCO 2009.

Databases searched were MEDLINE, the Cochrane Library, Cochrane Central Register of Controlled Trials, and EMBASE: Drugs and Pharmacology.

Acneform Rash:

• Moisturize.
• Begin topical antibiotic treatment (erythromycin, metronidazole, or nadifloxacin) twice daily for early-stage skin reactions.
• Systemic treatment should be started if grade 2 or higher skin reactions occur. Oral tetracyclines (doxycycline or minocycline) are recommended.

Xerotic Skin:

• Avoid hot showers and excessive use of soaps.
• Return moisture by applying emollients.

Pruritus:

• Skin moisturizer
• Urea or polidocanol-containing lotions

Fissures:

• Treat topically with propylene glycol 50% in water for 30 minutes under plastic occlusion every night, followed by application of hydrocolloid dressing.

Paronychia:

• Daily antiseptic baths to avoid bacterial superinfection.

Dermatology Referral:

• Lesions classified as grade 3 or higher should be managed collaboratively by an oncologist and a dermatologist.

Treatment Adjustments:

• Perform if skin reaction is grade 3 or higher.

Prophylactic Treatment:

• A number of unresolved issues remain, including whether or not to give prophylactic agents, and if given, whether to use topical or systemic approaches.

To date, no evidence-based treatment algorithms exist for the management of these skin reactions. The most important conclusion from this panel is that EGFR-inhibitor–induced skin reactions can be effectively treated at all stages and grades. The panel recommends to intervene as early as possible at the first sign of dermatologic reactions. Basic skin care combined with a specific therapy adapted to the stage and grade of the skin reaction is recommended. Randomized phase 3 trials are needed to make recommendations on prophylactic treatment.