Currently, the Common Terminology Criteria for Adverse Events (CTCAE) is used for identifying symptoms of skin toxicities and for grading. The latest version is CTCAE Version 4.03. Despite its widespread use and its utility, the CTCAE has not yet been validated. In addition, it is not designed specifically for multikinase inhibitors and may result in underreporting and poor grading of side effects.1

In 2011, the Multinational Association for Supportive Care in Cancer (MASCC) proposed the MASCC EGFRI Skin Toxicity Tool (MESTT) as a class-specific grading system for epidermal growth factor receptor (EGFR) inhibitors including oral EGFR tyrosine kinase inhibitors2, which is in the process of being validated. When compared to the CTCAE scale, there appears to be good correlation between the CTCAE and MESTT, but there is a tendency for the MESTT to report higher toxicity grades for some side effects such as rash, xerosis and paronychia.2 However, this grading system has specifically been developed for EGFRI and therefore addresses symptoms which occur with this group of agents. While not developed specifically for multikinase inhibitors, the MESTT system grades the side effects more accurately then the CTCAE in general.

For the purposes of this website, the CTCAE and MESTT grading systems will be used although other grading systems will be discussed.


1Lacouture ME, et al. A proposed EGFR inhibitor dermatologic adverse event-specific grading scale from the MASCC skin toxicity study group. Support Care Cancer. 2010;18:509-522.
2Chan A, Tan EH. How well does the MESTT correlate with CTCAE scale for the grading of dermatological toxicities associated with oral tyrosine kinase inhibitors? Support Care Cancer. 2011;19:1667-1674.

Last update: 22 August 2014