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Miller-Kobisher B, Suárez-Vega DV, Velazco de Maldonado GJ. Epidermal Growth Factor in Aesthetics and Regenerative Medicine: Systematic Review. J Cutan Aesthet Surg 2021; 14:137-146. [PMID: 34566354 PMCID: PMC8423211 DOI: 10.4103/jcas.jcas_25_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Epidermal Growth Factor (rhEGF) is a promising skin antiaging agent that successfully promotes skin wound repair, and it has been investigated in the past decade for these purposes. However, there are no updated systematic reviews, in English or English, that support the efficacy of rhEGF as a regenerative skin treatment or systematic reviews that compile the uses of rhEGF as facial aesthetic therapy and regenerative medicine. Aim: To describe the current state of facial aesthetic and regenerative medicine treatments in which rhEGF has been effectively used. Materials and Methods: An exhaustive search was carried out in “Medline” (via “PubMed”), “Cochrane,” “Bireme” through the Virtual Health Library (VHL), “Elsevier” via “Science Direct,” “Springer,” “SciELo,” “ResearchGate,” and Google Scholar. Studies related to the use of rhEGF in addressing skin disorders or skin aging are included. Results: Overall, 49 articles were found, which described the use of rhEGF for skin regeneration and restructuring. Efficacy in the regeneration of skin wounds was verified through the intradermal and topical application of formulations with rhEGF. Most clinical trials in aesthetics point to an effective inversion of skin aging. However, uncontrolled or randomized trials abound, so that does not represent enough evidence to establish its efficiency. There are transient adverse effects for both cases. Conclusion: The rhEGF considers an effective therapeutic alternative for patients with recalcitrant skin wounds and skin aging, as it is a potent and specific mitogenic factor for the skin.
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Affiliation(s)
| | - Dubraska V Suárez-Vega
- Department of Investigation, Dental Research Center, University of Los Andes (ULA), Mérida, Venezuela
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The extent to which the last decade has yielded additional treatment options for EGFR-associated rash besides classic treatment with antibiotics and corticosteroids - A systematic review. Eur J Oncol Nurs 2021; 50:101896. [PMID: 33493993 DOI: 10.1016/j.ejon.2021.101896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/20/2020] [Accepted: 01/03/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate the effectiveness of different interventions for the prevention and treatment of EGFRI treatment-induced rash (EGFRIr) that appeared in the last decade, excluding antibiotics and steroids products alone. METHOD A systematic review was performed in 2019 and was updated in 2020. The search strategy was limited to studies published within the last 10 years on the Medline database accessed via Pubmed and the Cochrane database. The search was performed using keywords combined with AND, OR. RESULTS The search yielded thirteen studies. The studies were divided into two categories, based on the intervention method used: four studies used creams containing vitamin K1 or vitamin K3 (henceforth classified as "Category A″) and nine studies ("Category B″) focused on different intervention methods such as laser treatment, Polydatin (PD) cream treatment, treatment with sunscreen, Adapalene gel treatment, topical aloe vera treatment, topical hydration treatment, the impact of a pre-emptive skin treatment and, finally, epidermal growth factor (EGF) ointment treatment. From "Category A″, the results vary as two studies found no benefit from cream use, while two studies indicated a possible improvement on skin reactions from cream use. In "Category B″, a benefit due to laser treatment was indicated, Polydatin-containing moisturizer showed a reduction in the incidence of rash grade ≥ II in patients treated with afatinib, while treatment with sunscreen demonstrated no benefit for the prevention of EGFRIr. Additionally, Adapalene gel use is not recommended as prophylaxis for EGFRIr, topical aloe vera may be used in the management for EGFRIr due to cetuximab, topical hydration resolved the EFGRIr, the pre-emptive skin treatment routine was well tolerated and the epidermal growth factor ointment improved all the symptoms due to EGFRI. CONCLUSIONS The results from the studies vary, although this study focuses on reviewing treatment interventions that can be utilized, apart from antibiotics and steroids, in order to alleviate the problems of the patients suffering from EGFRIr. More specifically, the authors of this review cannot draw a conclusion from "Category A″, as the efficacy of vitamin K for the management of EGFRIr is controversial. From "Category B″, some of the suggested treatments show encouraging results, while others may prove ineffective and rather harmful for the patients.
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Kim YS, Ji JH, Oh SY, Lee S, Huh SJ, Lee JH, Song K, Son CH, Roh MS, Lee GW, Lee J, Kim ST, Kim CK, Jang JS, Hwang IG, Ahn HK, Park LC, Oh SY, Kim S, Lee S, Lim D, Lee SI, Kang JH. A Randomized Controlled Trial of Epidermal Growth Factor Ointment for Treating Epidermal Growth Factor Receptor Inhibitor-Induced Skin Toxicities. Oncologist 2020; 25:e186-e193. [PMID: 31492766 PMCID: PMC6964120 DOI: 10.1634/theoncologist.2019-0221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/18/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The efficacy of epidermal growth factor (EGF) receptor (EGFR) inhibitors in patients with non-small cell lung cancer (NSCLC), pancreatic cancer (PC), or colorectal cancer (CRC) has been demonstrated. However, dermatological reactions to these inhibitors can cause significant physical and psychosocial discomfort. The objective of the present study was to evaluate the efficacy of EGF ointment for EGFR inhibitor-related skin adverse events (ERSEs). MATERIALS AND METHODS This placebo-controlled, double-blind, multicenter, pilot phase III trial enrolled patients with NSCLC, PC, or CRC treated with EGFR inhibitors. Patients with grade ≥2 ERSEs were included. Patients were randomized to three treatment arms: arm 1, placebo; arm 2, 1 ppm of EGF ointment; and arm 3, 20 ppm of EGF ointment. Patients applied ointment to their skin lesions twice daily. RESULTS Efficacy evaluation was available for 80 patients (9 for PC, 28 for NSCLC, and 43 for CRC). Responses were 44.4% in arm 1, 61.5% in arm 2, and 77.8% in arm 3. There was a linear correlation between EGF concentrations and responses (p = .012). Quality of life (QoL) was assessed for 74 patients. Maximum changes in composite scores by Skindex-16 after treatment were significantly different among arms (mean ± SD: -5.2 ± 8.6 for arm 1, -11.7 ± 14.2 for arm 2, and - 18.6 ± 17.7 for arm 3; p = .008). EGF arms showed significant improvement in emotions (p = .005) and functioning (p = .044) scores over the placebo arm. CONCLUSION EGF ointment is effective for managing ERSEs. It can also improve patients' QoL compared with placebo. Clinical trial identification number. NCT02284139 IMPLICATIONS FOR PRACTICE: Patients with non-small cell lung cancer, pancreatic cancer, or colorectal cancer who are treated with epidermal growth factor (EGF) receptor (EGFR) inhibitors may experience dermatologic reactions to their treatment. This study investigated the benefit of an EGF ointment in the treatment of these adverse events and observed the ointment to be effective in managing EGFR inhibitor-related skin adverse events.
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Affiliation(s)
- Young Saing Kim
- Department of Internal Medicine, Gachon University Gil Medical CenterIncheonRepublic of Korea
| | - Jun Ho Ji
- Division of Hematology‐Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of MedicineChangwonRepublic of Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong‐A University HospitalBusanRepublic of Korea
| | - Suee Lee
- Department of Internal Medicine, Dong‐A University HospitalBusanRepublic of Korea
| | - Seok Jae Huh
- Department of Internal Medicine, Dong‐A University HospitalBusanRepublic of Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Dong‐A University HospitalBusanRepublic of Korea
| | - Ki‐Hoon Song
- Department of Dermatology, National Cancer CenterGoyangRepublic of Korea
| | - Choon Hee Son
- Department of Pulmonology, Dong‐A University HospitalBusanRepublic of Korea
| | - Mee Sook Roh
- Department of Pathology, Dong‐A University College of MedicineBusanRepublic of Korea
| | - Gyeong Won Lee
- Department of Internal Medicine, Gyeongsang National University HospitalJinjuRepublic of Korea
| | - Jeeyun Lee
- Department of Medicine, Samsung Medical CenterSeoulRepublic of Korea
| | - Seung Tae Kim
- Department of Medicine, Samsung Medical CenterSeoulRepublic of Korea
| | - Chan Kyu Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon HospitalBucheonRepublic of Korea
| | - Joung Soon Jang
- Department of Internal Medicine, Chung‐Ang University College of MedicineSeoulRepublic of Korea
| | - In Gyu Hwang
- Department of Internal Medicine, Chung‐Ang University College of MedicineSeoulRepublic of Korea
| | - Hee Kyung Ahn
- Department of Internal Medicine, Gachon University Gil Medical CenterIncheonRepublic of Korea
| | - Lee Chun Park
- Division of Hematology‐Oncology, Department of Medicine, Kosin University College of MedicineBusanRepublic of Korea
| | - So Yeon Oh
- Department of Internal Medicine, Pusan National University Yangsan HospitalYangsanRepublic of Korea
| | - Seong‐Geun Kim
- Department of Internal Medicine, Pusan National University Yangsan HospitalYangsanRepublic of Korea
| | - Sang‐Cheol Lee
- Department of Internal Medicine, Soonchunhyang University Hospital CheonanCheonanRepublic of Korea
| | - Do‐Hyoung Lim
- Department of Internal Medicine, Dankook University College of MedicineCheonanRepublic of Korea
| | - Soon Il Lee
- Department of Internal Medicine, Dankook University College of MedicineCheonanRepublic of Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Gyeongsang National University HospitalJinjuRepublic of Korea
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Hsu YH, Shen WC, Wang CH, Lin YF, Chen SC. Hand-foot syndrome and its impact on daily activities in breast cancer patients receiving docetaxel-based chemotherapy. Eur J Oncol Nurs 2019; 43:101670. [PMID: 31586645 DOI: 10.1016/j.ejon.2019.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/16/2019] [Accepted: 09/29/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Breast cancer patients who undergo docetaxel-based chemotherapy regimens can have hand-foot syndrome (HFS), which negatively impacts their ability to perform daily activities. The purpose of the study was to assess, in breast cancer patients receiving chemotherapy: the perceived levels of HFS-related symptoms of the feet, hands or fingers; and HFS-related restrictions in daily activities; as well as to identify factors associated with these symptoms and restrictions. METHODS This cross-sectional study examined breast cancer patients who received docetaxel-based chemotherapy from the general surgery outpatient department and oncology outpatient department of a medical center in northern Taiwan. A set of structured questionnaires were used to measure patients' HFS-related symptoms and HFS-related restrictions in daily activities. RESULTS Of the 85 breast cancer patients studied, 41.2% reported HFS. Patients had higher level of HFS-related foot symptoms than HFS-related hand or fingers symptoms. Greater restriction in HFS-related daily activities was associated with more HFS-related hand or fingers symptoms and more HFS-related foot symptoms; these factors explained 44.7% of the variance in restriction of activities. CONCLUSION Skin care and patient education should be provided to manage the HFS of breast cancer patients receiving chemotherapy.
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Affiliation(s)
- Ya-Hui Hsu
- Department of Nursing, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Chi Shen
- Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Hui Wang
- Department of Nursing, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Fen Lin
- Department of Nursing, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Ching Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; School of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Department of Radiation Oncology and Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Lee JH, Ju HJ, Kwon HS, Jung HM, Kim GM, Bae JM, An HJ. Efficacy of topical epidermal growth factor cream for patients with epidermal growth factor receptor inhibitor-induced acneiform eruption: a randomized controlled trial. Br J Dermatol 2019; 182:219-221. [PMID: 31301244 DOI: 10.1111/bjd.18340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J H Lee
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H J Ju
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H S Kwon
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H M Jung
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - G M Kim
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - J M Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H J An
- Division of Medical Oncology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Shah RR, Shah DR. Safety and Tolerability of Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors in Oncology. Drug Saf 2019; 42:181-198. [PMID: 30649743 DOI: 10.1007/s40264-018-0772-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) that target epidermal growth factor receptor (EGFR) have dramatically improved progression-free survival in non-small-cell lung cancer (NSCLC) patients who carry sensitizing EGFR-activating mutations and in patients with breast and pancreatic cancers. However, EGFR-TKIs are associated with significant and disabling undesirable effects that adversely impact on quality of life and compliance. These effects include dermatological reactions, diarrhoea, hepatotoxicity, stomatitis, interstitial lung disease and ocular toxicity. Each individual EGFR-TKI is also associated with additional adverse effect(s) that are not shared widely by the other members of its class. Often, these effects call for dose reduction, treatment discontinuation or pharmacotherapeutic intervention. Since dermatological effects result from on-target effects on wild-type EGFR, rash is often considered to be a biomarker of efficacy. A number of studies have reported better outcomes in patients with skin reactions compared with those without. This has led to a 'dosing-to-rash' strategy to optimize therapeutic outcomes. Although conceptually attractive, there is currently insufficient evidence-based support for this strategy. While skin reactions following EGFR-TKIs are believed to result from an effect on wild-type EGFR, their efficacy is related to effects on mutant variants of EGFR. It is noteworthy that newer EGFR-TKIs that spare wild-type EGFR are associated with fewer dermatological reactions. Furthermore, secondary mutations such as T790M in exon 20 often lead to development of resistance to the clinical activity and efficacy of first- and second-generation EGFR-TKIs. This has stimulated the search for later-generations of EGFR-TKIs with the ability to overcome this resistance and with greater target selectivity to spare wild-type EGFR in expectations of an improved safety profile. However, available data reviewed herein indicate that not only are these newer agents associated with the aforementioned adverse effects typical of earlier agents, but they are also susceptible to resistance due to tertiary mutations, most frequently C797S. At least three later-generation EGFR-TKIs, canertinib, naquotinib and rociletinib, have been discontinued from further development in NSCLC following concerns about their safety and risk/benefit.
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Matsumura S, Terao M, Itami S, Katayama I. Local cortisol activation is involved in EGF-induced immunosuppression. DERMATO-ENDOCRINOLOGY 2018; 9:e1412018. [PMID: 29484105 PMCID: PMC5821158 DOI: 10.1080/19381980.2017.1412018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/28/2017] [Indexed: 10/25/2022]
Abstract
The major effects of the epidermal growth factor receptor (EGFR) signalling pathway on keratinocytes are cell proliferation, cell differentiation, and wound healing. In addition to these effects, an immunosuppressive effect of EGFR signalling has been reported. However, the precise mechanism of immunosuppression by EGFR signalling is not well understood. In this study, we clarified the involvement of increased local cortisol activation in EGFR signalling-induced immunosuppression in keratinocytes. EGF treatment up-regulated the expression of 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1) and supernatant cortisol levels in a dose-dependent manner in keratinocytes. 11β-HSD1 is an enzyme that catalyses the conversion of cellular hormonally inactive cortisone into active cortisol. qRT-PCR and ELISA assays indicated that EGF significantly decreased tumour necrosis factor α (TNF- α)-induced interleukin-6 (IL-6) expression in keratinocytes. Similarly, 11β-HSD1 overexpression significantly decreased TNF-α-induced IL-6 expression. We evaluated the role of 11β-HSD1 in immunosuppression through EGFR signalling. Blockade of 11β-HSD1 via 11β-HSD1 inhibitor reversed both the expression and production of TNF-α-induced IL-6, which was decreased by EGF in keratinocytes. Therefore, increased local cortisol activation by 11β-HSD1 is involved in EGFR signalling-induced immunosuppression in keratinocytes. Finally, we evaluated whether EGFR inhibition by cetuximab affects the expression of 11β-HSD1. We found that 0.1 µg cetuximab decreased 11β-HSD1 transcript levels in keratinocytes. The changes in 11β-HSD1 were more apparent in TNF-α-treated cells. As 11β-HSD1 expression in keratinocytes is associated with inflammation and cell proliferation, this mechanism may be associated with adverse skin reactions observed in patients treated with EGFR inhibitors.
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Affiliation(s)
- Sayaka Matsumura
- Department of Dermatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Mika Terao
- Department of Dermatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan.,Department of Regenerative Dermatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Satoshi Itami
- Department of Regenerative Dermatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Ichiro Katayama
- Department of Dermatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
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Hofheinz RD, Deplanque G, Komatsu Y, Kobayashi Y, Ocvirk J, Racca P, Guenther S, Zhang J, Lacouture ME, Jatoi A. Recommendations for the Prophylactic Management of Skin Reactions Induced by Epidermal Growth Factor Receptor Inhibitors in Patients With Solid Tumors. Oncologist 2016; 21:1483-1491. [PMID: 27449521 PMCID: PMC5153350 DOI: 10.1634/theoncologist.2016-0051] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/02/2016] [Indexed: 01/15/2023] Open
Abstract
: Inhibition of the epidermal growth factor receptor (EGFR) is an established treatment that extends patient survival across a variety of tumor types. EGFR inhibitors fall into two main categories: anti-EGFR monoclonal antibodies, such as cetuximab and panitumumab, and first-generation tyrosine kinase inhibitors, such as afatinib, gefitinib, and erlotinib. Skin reactions are the most common EGFR inhibitor-attributable adverse event, resulting in papulopustular (acneiform) eruptions that can be painful and debilitating, and which may potentially have a negative impact on patients' quality of life and social functioning, as well as a negative impact on treatment duration. Shortened treatment duration can, in turn, compromise antineoplastic efficacy. Similarly, appropriate management of skin reactions is dependent on their accurate grading; however, conventional means for grading skin reactions are inadequate, particularly within the context of clinical trials. Treating a skin reaction only once it occurs (reactive treatment strategies) may not be the most effective management approach; instead, prophylactic approaches may be preferable. Indeed, we support the viewpoint that prophylactic management of skin reactions should be recommended for all patients treated with EGFR inhibitors. Appropriate prophylactic management could effectively reduce the severity of skin reactions in patients treated with EGFR inhibitors and therefore has the potential to directly benefit patients and improve drug adherence. Accordingly, here we review published and still-emerging data, and provide practical and evidence-based recommendations and algorithms regarding the optimal prophylactic management of EGFR inhibitor-attributable skin reactions. IMPLICATIONS FOR PRACTICE Epidermal growth factor receptor (EGFR) inhibitors extend patient survival across a variety of tumor types. The most common EGFR inhibitor-attributable adverse events are skin reactions. Prophylactic-rather than reactive-management of skin reactions for all patients receiving EGFR inhibitors should be recommended because appropriate prophylaxis could effectively reduce the severity of skin reactions; thus, the derivation of highly effective prophylactic strategies has the potential to directly benefit patients. Accordingly, a review of the available data leads to practical and evidence-based recommendations and algorithms regarding the optimal prophylactic management of EGFR inhibitor-attributable skin reactions.
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Affiliation(s)
- Ralf-Dieter Hofheinz
- TagesTherapieZentrum am Interdisziplinären Tumorzentrum, Mannheim Universitätsmedizin, Mannheim, Germany
| | - Gaël Deplanque
- Département d'Oncologie, Service d'Oncologie Médicale, Lausanne, Switzerland
| | | | | | - Janja Ocvirk
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | | | - Jun Zhang
- Ruijin Hospital of Shanghai Second Medical University, Shanghai, People's Republic of China
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Phase II trial of epidermal growth factor ointment for patients with Erlotinib-related skin effects. Support Care Cancer 2015; 24:301-309. [PMID: 26041481 DOI: 10.1007/s00520-015-2783-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The efficacy of erlotinib, the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, has been demonstrated in patients with non-small cell lung cancer (NSCLC) and pancreatic cancer (PC). In the present study, we evaluated the effect of epidermal growth factor (EGF) ointment on erlotinib-related skin effects (ERSEs). METHODS This was an open-label, non-comparative, multicenter, phase II trial. The patients included those diagnosed with NSCLC or PC who were treated with erlotinib. The effectiveness of the ointment was defined as follows: (1) grade 2, 3, or 4 ERSEs downgraded to ≤ grade 1 or (2) grade 3 or 4 ERSEs downgraded to grade 2 and persisted for at least 2 weeks. RESULTS Fifty-two patients from seven institutes in Korea were enrolled with informed consent. The final assessment included 46 patients (30 males, 16 females). According to the definition of effectiveness, the EGF ointment was effective in 36 (69.2%) intention to treat patients. There were no statistically significant differences in the effectiveness of the EGF ointment by gender (p = 0.465), age (p = 0.547), tumor type (p = 0.085), erlotinib dosage (p = 0.117), and number of prior chemotherapy sessions (p = 0.547). The grading for the average National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE) rating of rash/acne and itching improved from 2.02 ± 0.83 to 1.13 ± 0.89 and 1.52 ± 0.84 to 0.67 ± 0.90, respectively (p < 0.001). The most common reason for discontinuing the study was progression of cancer (37%). CONCLUSIONS Based on the results, the EGF ointment is effective for ERSEs, regardless of gender, age, type of tumor, and dosage of erlotinib. The EGF ointment evenly improved all kinds of symptoms of ERSEs. CLINICAL TRIAL REGISTRATION NO ClinicalTrials.gov identifier: NCT01593995.
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