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Terminology used to define side effects

Currently, the Common Terminology Criteria for Adverse Events (CTCAE) are used for identifying symptoms of dermatological side effects and for grading. The latest version is CTCAE Version 5.0, which was published in November 2017. The previous version, CTCAE Version 4.03, had been in effect since Jun 2010. 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 At the same time, toxicity-specific grading systems developed to date focus only on EGFR inhibitors.

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 inhibitors1, 2. When compared to the CTCAE scale (v4.0), 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.3

However, this grading system has specifically been developed for EGFR inhibitors and therefore addresses symptoms, which occur with this group of agents. While not developed specifically for multikinase inhibitors, the MESTT system grades skin side effects more accurately than the CTCAE in general.

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


  1. Lacouture ME, et al. Support Care Cancer. 2010;18:509-522.
  2. MASCC. EGFR Inhibitor Skin Toxicity Tool (MESTT).
  3. Chan A, Tan EH. Support Care Cancer. 2011;19:1667-1674.

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