AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

Update on Cutaneous Reactions to Targeted and Immune Cancer Therapy

Description

In a recent session focusing on cutaneous reactions related to targeted and immune cancer therapies, Dr. Anisha Patel from UTMD Anderson Cancer Center presented insights into the evolving landscape of dermatologic toxicities associated with these treatments. With advancements in targeted therapies since the early 2000s, the incidence of skin reactions has increased, particularly with epidermal growth factor receptor (EGFR) inhibitors, which yield a high rate of cutaneous eruptions. This session explored the management of toxicities from both targeted therapy and checkpoint inhibitors. Dr. Patel highlighted the significant role dermatologists play in the oncology team, emphasizing the necessity for early intervention due to the impacts of skin reactions on a patient’s treatment regimen. Treatment strategies were discussed, including the use of topical steroids, oral tetracyclines for acneiform eruptions, and novel approaches involving medications like dupilumab for eczema linked to EGFR inhibitors. Additionally, the talk addressed complications from combination therapies, specifically the newer antibody-drug conjugates and their associated dramatic skin toxicities. The importance of ongoing research into mechanisms of these reactions, management algorithms, and collaboration among oncology and dermatology specialists was underscored as essential for optimizing patient outcomes while maintaining the efficacy of cancer therapies.

View more

Conclusions

  • Targeted therapies, especially EGFR inhibitors, have a significantly higher incidence of cutaneous reactions compared to conventional treatments.
  • Combination therapies in oncology can lead to a 100% incidence of rashes affecting dosage and treatment schedules.
  • The management of cutaneous toxicities requires a collaborative approach involving dermatology and oncology to optimize patient outcomes.
  • EGFR inhibitors and MEK inhibitors frequently result in acneiform eruptions, necessitating specific treatment strategies to avoid exacerbating symptoms.
  • Antibiotic resistance poses a significant challenge in managing skin infections associated with oncology treatments, highlighting the need for judicious antibiotic use.
  • Patients on oral retinoids exhibit an increased risk of superinfection and should be monitored closely to manage these complications effectively.
  • A structured approach to treatment, including topical steroids or systemic agents like dupilumab, can provide relief for patients suffering from inflammatory skin reactions.
  • Newer targeted agents, including bispecific antibodies and antibody-drug conjugates, show promise but come with their own set of dermatological toxicities that need to be addressed promptly.
  • Bigby M. Rates of cutaneous reactions to drugs. Arch Dermatol. 2001;137(6):765-70.
  • Lacouture ME. Mechanisms of cutaneous toxicities to EGFR inhibitors. Nat Rev Cancer. 2006;6(10):803-12.
  • Andrews ED, Garg N, Patel AB. A Retrospective Chart Review on Oral Retinoids as a Treatment for Epidermal Growth Factor Receptor Inhibitor and Mitogen-activated Protein Kinase Kinase Inhibitor Induced Acneiform Eruptions. J Am Acad Dermatol. 2019;
  • Chiang HC, Anadkat MJ. Isotretinoin for high-grade or refractory epidermal growth factor receptor inhibitor-related acneiform papulopustular eruptions. J Am Acad Dermatol. 2013;69(4):657-8.
  • Hirotsu K, Dang TM, Li S, et al. Association of Antibiotic Resistance With Antibiotic Use for Epidermal Growth Factor Receptor Inhibitor-Related Papulopustular Eruption. JAMA Dermatol. 2019;155(7):848-850.
  • Basse C, Chabanol H, Bonte PE, et al. Management of cutaneous toxicities under amivantamab (anti MET and anti EGFR bispecific antibody) in patients with metastatic non-small cell lung cancer harboring EGFR Exon20ins: towards a proactive, multidisciplinary approach. Lung Cancer. 2022 Nov;173:116-123. PMID: 36198244.
  • Park K, Haura EB, Leighl NB, et al. Amivantamab in EGFR Exon 20 Insertion-Mutated Non-Small-Cell Lung Cancer Progressing on Platinum Chemotherapy: Initial Results From the CHRYSALIS Phase I Study. J Clin Oncol. 2021 Oct 20;39(30):3391-3402 PMID: 34339292.
  • Nguyen CV, Zheng L, Zhou XA, et al. High-Dose Vitamin D for the Management of Toxic Erythema of Chemotherapy in Hospitalized Patients. JAMA Dermatol. 2023;159(2):219-222.
  • Zhang Y, Grice S, Wang N, et al. HLA-C*15:02 and epidermal growth factor receptor inhibitor-induced erosive pustular dermatosis of the scalp. Clin Exp Dermatol. 2023 Oct 25;48(11):1260-1265.
  • Zhou C, Tang KJ, Cho BC, Liu Bet al; PAPILLON Investigators. Amivantamab plus Chemotherapy in NSCLC with EGFR Exon 20 Insertions. N Engl J Med. 2023 Nov 30;389(22):2039-2051. PMID: 37870976.