1277P - Prophylactic treatment for rash induced by EGFR inhibitor Improves rash without compromising on efficacy the PanCanadian Rash Trial: A randomized P...

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Complications of Treatment
Supportive Care
Non-Small-Cell Lung Cancer, Metastatic
Presenter Barbara Melosky
Citation Annals of Oncology (2014) 25 (suppl_4): iv426-iv470. 10.1093/annonc/mdu349
Authors B. Melosky1, R. Burkes2, Q.S. Chu3, D. Hao4, C. Ho5, H. Anderson6, C. Lee7, N. Leighl8, N. Murray9, S. Sun10, R. Winston11, W. Lam12, J. Laskin10
  • 1Medical Oncology, British Columbia Cancer Agency, V5Z 4E6 - Vancouver/CA
  • 2Medicine, Mount Sinai Hospital, CA-M5G 1X5 - Toronto/CA
  • 3Oncology, University of Alberta Cross Cancer Institute, T6G 1Z2 - Edmonton/CA
  • 4Oncology, Tom Baker Cancer Centre/University of Calgary, T2N 4N2 - Calgary/CA
  • 5Medical Oncology, British Columbia Cancer Agency, Vancouver/CA
  • 6Medical Oncology, British Columbia Cancer Agency, Victoria/CA
  • 7Fraser Valley Centre, British Columbia Cancer Agency, Fraser Valley/CA
  • 8Medical Oncology, Princess Margaret Hospital, Toronto/CA
  • 9Medical Oncology, BC Cancer Agency, V5Z4E6 - Vancouver/CA
  • 10Medical Oncology, British Columbia Cancer Agency, vancouver/CA
  • 11Medical Oncology, British Columbia Cancer Agency, Abbotsford/CA
  • 12Burnaby Hospital Regional Cancer Centre, Burnaby Hospital Regional Cancer Centre, CA-V5G 2X6 - Burnaby/CA

Abstract

Aim

Erlotinib is approved for the treatment of patients with metastatic NSCLC following progression of chemotherapy as well for patients who harbour an EGFR mutation. Rash may limit exposure to drug and compromise efficacy. The objective of our study was to determine the proper treatment of EGFR inhibitor-induced rash in the 2nd line or greater setting. A secondary objective was to prospectively observe the relationship between rash and survival and to see if intervention for rash was detrimental.

Methods

150 patients metastatic NSCLC to be started on erlotinib in 2nd/3rd line were randomized to : Arm 1: Prophylactic: Minocycline (150 po bid 4 weeks) on day 1 of erlotinib Arm 2: Reactive: Topical clindamycin plus hydrocortisone +/- minocycline upon rash occurrence Arm 3: Control: No treatment of rash unless severe (Grade 3)

Results

Although not statistically significant, previous results showed Arms 1 and 2 had the longest overall survival from randomization. Arm 1: 7.6 months, Arm 2: 8.0 months, Arm 3: 6.0 months p = 0.38 Median survival was analyzed for the 150 patients for worst grade of rash experienced. Survival was significantly longer in patients who experienced severe or moderate rash (Grade 3 or 2) versus mild or no rash (Grade 0/1). Grade 3 rash: 11.4 months, Grade 2 rash: 10.1 months, Grade0/1 rash: 5.5 months p = 0.0093 Porphylactic minocycline in Arm 1 increased Grade 2 and decreased Grade 3 rash significantly. p= 0.3.

Number and Percent of Patients with Worst Rash Grade for each Treatment Arm

Arm RashGrade 0/1 N% RAsh Grade 2 N% RAsh Grade 3 N% Total
1 25 (50%) 20 (40%) 5 (9.5%) 50
2 28 (46%) 15 (30%) 7 (14.3%) 50
3 28 (46%) 5 (10%) 17 (34.1%) 50

Conclusions

In this prospective trial, a relationship between severity of rash and survival was seen. Moderate (Grade2) and severe (Grade3) rash demonstrated a superior overall survival compared to no or mild (Grade 1) rash. Prophylactic minocycline reduced the incidence of severe Grade 3 rash but increased the moderate Grade2 rash. Prophylactic minocyline should be considered in patients upon initiation of erlotinib therapy.

Disclosure

All authors have declared no conflicts of interest.