Information for Healthcare Professionals
At the time of the creation of this website (2009), there were no clinical study outcome-based guidelines for the management of these dermatological toxicities. As such, treatment algorithms here are largely compiled from expert statements, literature review (of review articles, reports of small cohort studies and limited data from small prospective, randomised clinical trials) and expert guidance from a dermatologist, Professor Siegfried Segaert (University Hospital Leuven, Leuven, Belgium), and an oncology nurse Liesbeth Lemmens (University Hospital Leuven, Leuven, Belgium).
Update: In 2011, the MASCC published a Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities.
EGFRIs are indicated for the management of colorectal, lung, pancreatic, breast, and head and neck cancers, with ongoing investigation in other indications. Unlike cytotoxic chemotherapy, the specificity of the EGFRIs means that treatment is associated with only minimal non-specific and haematological side effects.
The most common EGFRI-related adverse events are dermatological due to the concurrent inhibition of physiological EGFR signalling in the skin; to date, this is a class-effect of all EGFRIs. Most patients experience mild to moderate symptoms, although the associated physical and psychosocial discomfort can be significant. Consequently, such dermatological toxicities in addition to patient compliance may lead to suboptimal dose-intensity delivery.
It is important to note, however, that the dermatological advice for EGFRI-related skin toxicity is supportive; here the primary objective is to maintain quality of life and to continue the potentially life-extending anti-tumour treatment. This is in contrast to the dermatological advice given in the setting of most other anti-tumour therapies, when the treatment paradigm is causal; in that setting, the dermatological advice is to identify and stop the responsible drug.
We therefore aim to:
- Provide expert advice for prophylaxis and treatment of skin toxicities.
- Provide supportive measures to maintain potentially beneficial EGFRI treatment.
- Stimulate clinical research for evaluation of mechanistically driven therapies.
- Provoke research on the development of adequate staging systems.