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When EGFRIs are combined with radiotherapy (eg for head and neck cancer or cervical cancer) or chemotherapy, side-effect management remains unaltered, as the currently recommended therapies do not interfere with radiotherapy or chemotherapy.1,2,3

It is noteworthy that radiation upregulates EGFR expression in non-irradiated skin,2 and a synergy has been described between EGFRIs and radiation in tumour models.4 Skin areas that previously underwent radiotherapy are, however, characteristically spared from the acneiform eruption.5 In contrast, concomitant cetuximab and radiotherapy appear to increase the incidence of severe radiodermitis.6

General recommendations: When radiation portal and rash do not overlap, both areas should be specifically treated according to the type of skin reaction, and the general recommendations for care of both irradiated skin2 and acneiform eruption7 apply. As the currently recommended therapies for EGFRI-related skin toxicity (topical metronidazole and oral tetracyclines) do not interfere with radiotherapy, side-effect management remains unaltered when EGFRIs are given in combination with radiotherapy.2 This also applies for the treatment of radiodermatitis when radiotherapy is given in combination with EGFRI treatment.2

References

1Segaert S et al. Eur J Cancer 2009; 45(Suppl 1): 295-308.
2Bernier J et al. Ann Oncol 2008; 19: 142-149.
3Jatoi A et al. Cancer 2008; 113: 847-853.
4Bonner JA et al. J Clin Oncol 2000; 18: 47S-53S.
5Mitra SS & Simcock R. J Clin Oncol 2006; 24: e28-e29.
6Tejwani A et al. Cancer 2009; 115: 1286-1299.
7Segaert S. Targeted Oncol 2008; 3: 245-251.

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