Prophylactic treatments reduce panitumumab-related skin toxicity

NEW YORK (Reuters Health) - For cancer patients receiving epidermal growth factor receptor (EGFR) inhibitors like panitumumab, prophylactic treatment with moisturizers, sunscreen, topical corticosteroids and oral antibiotics significantly reduces the incidence of severe skin toxicities, improves quality of life, and may impact cancer outcomes, according to results of a randomized study reported at the annual meeting of the American Society of Clinical Oncology in Orlando.

The skin toxicity caused by EGFR inhibitors "prevents many patients from agreeing to take these drugs and either delays or interrupts treatment for many others, reducing the effectiveness of therapy," Dr. Edith Mitchell, of Thomas Jefferson University in Philadelphia and study leader, noted in a statement from the meeting.

"Prophylactic skin treatment is likely to become a new standard of care for patients receiving these drugs," she added.

Dr. Mitchell and colleagues studied 95 metastatic colorectal cancer patients. They randomly assigned 48 to prophylactic skin treatment with topically applied sunscreen, moisturizers and corticosteroids with oral antibiotics (doxycycline) starting 24 hours before the first dose of panitumumab-based therapy and 47 to reactive skin toxicity treatment (treatment after the skin rash developed).

According to the investigators, 29% of patients in the prophylactic group experienced skin toxicity versus 62% of those in the reactive treatment group.

"Results showed that the incidence of grade 2 or higher skin toxicities -- the primary endpoint - was reduced substantially by prophylactic or preemptive skin treatment," Dr. Mitchell reported at an ASCO briefing. "It resulted in less than 50% of the skin toxicities of the reactive skin treatment."

"For grade 3 or higher skin toxicities -- the most serious toxicities -- the prophylactic skin treatment resulted in less than one third of the serious toxicities" compared with reactive skin treatment, she added.

Prophylactic skin treatment also reduced the incidence of non-dermatologic toxicities including nausea/vomiting, fatigue, diarrhea, neutropenia and dehydration, and improved the quality of life.

Additionally, "prophylactic skin treatment reduced the number of panitumumab dose delays, with only 1% of patients in the prophylactic skin treatment arm experiencing a dose delay compared with 6% of patients in the reactive skin treatment arm," Dr. Mitchell reported, which could potentially have a positive impact on cancer outcomes.

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