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Tisack A, Mohammad TF. Drug-Induced Pigmentation: A Review. Drugs 2024:10.1007/s40265-024-02062-z. [PMID: 39085684 DOI: 10.1007/s40265-024-02062-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 08/02/2024]
Abstract
Drug-induced pigmentation (DIP) is estimated to account for 20% of all cases of acquired hyperpigmentation. Over 50 agents have been implicated, including antibiotics, antimalarials, antiretrovirals, antipsychotics, prostaglandin analogs, heavy metals, and chemotherapeutic agents. The skin, mucosal surfaces, nails, and hair can all be affected, with the color, distribution, onset, and duration of pigmentation varying between offending agents. Both a thorough physical examination and medication history are necessary to determine the offending agent. In terms of mechanism, DIP occurs most frequently through the accumulation of melanin within the dermis but also by drug accumulation, pigment synthesis, and iron deposition. Photoprotection, including applying a broad-spectrum sunscreen, wearing photoprotective clothing, and seeking shade, plays an important role in the prevention of exacerbation of DIP. Multiple lasers, including the picosecond alexandrite, Q-switched Nd:YAG, Q-switched alexandrite, and Q-switched ruby lasers, have been successful in obtaining clearance of DIP. In this review, we examine the unique characteristics of each of the inciting agents in terms of incidence, clinical presentation, time to onset and resolution, and pathogenesis.
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Affiliation(s)
- Aaron Tisack
- Department of Dermatology, Henry Ford Health, 3031 W Grand Blvd, Detroit, MI, 48202, USA
| | - Tasneem F Mohammad
- Department of Dermatology, Henry Ford Health, 3031 W Grand Blvd, Detroit, MI, 48202, USA.
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2
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Xu P, Yang L, Lai S, Yang F, Kuroda Y, Zhang H, Tsuruta D, Katayama I. Effects of EGFR-TKI on epidermal melanin unit integrity: Therapeutic implications for hypopigmented skin disorders. Pigment Cell Melanoma Res 2024; 37:514-529. [PMID: 38705722 DOI: 10.1111/pcmr.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Abstract
Epidermal melanin unit integrity is crucial for skin homeostasis and pigmentation. Epidermal growth factor (EGF) receptor (EGFR) is a pivotal player in cell growth, wound healing, and maintaining skin homeostasis. However, its influence on skin pigmentation is relatively unexplored. This study investigates the impact and underlying mechanisms of EGFR inhibitors on skin pigmentation. We evaluated EGF and EGFR expression in various skin cells using quantitative real-time PCR, Western blot, and immunofluorescence. EGF and EGFR were predominantly expressed in epidermal keratinocytes, and treatment with the EGFR tyrosine kinase inhibitors (EGFR-TKIs) gefitinib and PD153035 significantly increased stem cell factor (SCF) and endothelin-1 (ET-1) expression in cultured keratinocytes. Enhanced melanocyte migration and proliferation were observed in co-culture, as evidenced by time-lapse live imaging and single-cell tracking assays. Furthermore, topical application of gefitinib to guinea pig dorsal skin induced increased pigmentation and demonstrated efficacy in mitigating rhododendrol-induced leukoderma. Suppression of EGF signaling indirectly enhanced skin pigmentation by upregulating SCF and ET-1 in epidermal keratinocytes. This novel mechanism highlights the pivotal role of EGF signaling in regulating skin pigmentation, and topical EGFR-TKI therapy at an appropriate dose may be a promising approach for depigmentation disorder management.
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Affiliation(s)
- Ping Xu
- Department of Pigmentation Research and Therapeutics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Department of Dermatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lingli Yang
- Department of Pigmentation Research and Therapeutics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Sylvia Lai
- Department of Pigmentation Research and Therapeutics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Fei Yang
- Department of Pigmentation Research and Therapeutics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Biological Science Research Laboratories, Kao Corporation, Odawara, Japan
| | - Yasutaka Kuroda
- Department of Pigmentation Research and Therapeutics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Biological Science Research Laboratories, Kao Corporation, Odawara, Japan
| | - Huimin Zhang
- Department of Dermatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Daisuke Tsuruta
- Department of Dermatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Ichiro Katayama
- Department of Pigmentation Research and Therapeutics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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3
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Ghasemiyeh P, Fazlinejad R, Kiafar MR, Rasekh S, Mokhtarzadegan M, Mohammadi-Samani S. Different therapeutic approaches in melasma: advances and limitations. Front Pharmacol 2024; 15:1337282. [PMID: 38628650 PMCID: PMC11019021 DOI: 10.3389/fphar.2024.1337282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Melasma is a chronic hyperpigmentation skin disorder that is more common in the female gender. Although melasma is a multifactorial skin disorder, however, sun-exposure and genetic predisposition are considered as the main etiologic factors in melasma occurrence. Although numerous topical and systemic therapeutic agents and also non-pharmacologic procedural treatments have been considered in melasma management, however, the commonly available therapeutic options have several limitations including the lack of sufficient clinical effectiveness, risk of relapse, and high rate of unwanted adverse drug reactions. Recruitment of nanotechnology for topical drug delivery in melasma management can lead to enhanced skin penetration, targeted drug delivery to the site of action, longer deposition at the targeted area, and limit systemic absorption and therefore systemic availability and adverse drug reactions. In the current review, first of all, the etiology, pathophysiology, and severity classification of melasma have been considered. Then, various pharmacologic and procedural therapeutic options in melasma treatment have been discussed. Afterward, the usage of various types of nanoparticles for the purpose of topical drug delivery for melasma management was considered. In the end, numerous clinical studies and controlled clinical trials on the assessment of the effectiveness of these novel topical formulations in melasma management are summarized.
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Affiliation(s)
- Parisa Ghasemiyeh
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rahil Fazlinejad
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Kiafar
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shiva Rasekh
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Soliman Mohammadi-Samani
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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4
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Desai AD, Wang Y, Nadarajah CC, Lipner SR. Cross-Sectional Analysis of Paronychias in the National Electronic Injury Surveillance System 1999–2018. Skin Appendage Disord 2022; 8:454-461. [PMID: 36407642 PMCID: PMC9672864 DOI: 10.1159/000525032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Paronychia is the most common hand infection. Prior paronychia studies were limited by small patient numbers. We conducted a national-level analysis over two decades, analyzing demographics, etiologies, and trends in paronychia cases. Methods We conducted a retrospective analysis of paronychia cases in the 1999–2018 National Electronic Injury Surveillance System database. Sex, race, age, and cause were recorded and compared using χ<sup>2</sup>, ANOVA, and t tests. Multivariable linear regression analysis assessed changes in age, weight, and sex over time. Results We analyzed a total of 2,512 cases, with an average age of 27.6 ± 20.6 years, 45.5% females, and 25.6% white and 28.6% black patients. In multivariable linear regression, both age and weight significantly increased over time. Manicuring was the most common etiology (30.9%), increasing in incidence over time and with a higher frequency in adults (p < 0.0001) and females (p < 0.0001). There was a significant decrease in pediatric paronychia cases over time, particularly in 0- to 4-year-olds. Possible limitations include missed paronychia cases or additional non-paronychia cases due to improper coding, infrequent race reporting, and inability to analyze treatments or distinguish between paronychia subtypes. Conclusions Paronychia cases were associated with increased age and weight over time with different presentations by age. Manicuring represents the largest growing paronychia etiology.
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Affiliation(s)
- Amar D. Desai
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Yu Wang
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Shari R. Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
- *Shari R. Lipner,
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5
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Maghfour J, Olayinka J, Hamzavi IH, Mohammad TF. A Focused review on the pathophysiology of post-inflammatory hyperpigmentation. Pigment Cell Melanoma Res 2022; 35:320-327. [PMID: 35306737 DOI: 10.1111/pcmr.13038] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/22/2022] [Accepted: 03/16/2022] [Indexed: 11/26/2022]
Abstract
Post-inflammatory hyperpigmentation (PIH) is one of the most common disorders of acquired hyperpigmentation. It often develops following cutaneous inflammation and is triggered by various stimuli, from inflammatory and autoimmune conditions to iatrogenic causes and mechanical injuries. While it is well established that an increase in melanin production and distribution within the epidermis and dermis is a hallmark feature of this condition, the exact mechanisms underlying PIH are not completely understood. This article aims to review the current evidence on the pathophysiology of PIH as the cellular and molecular mechanism of PIH represents a promising avenue for the development of novel, targeted therapies.
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Affiliation(s)
- Jalal Maghfour
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Jadesola Olayinka
- Medical School, SUNY Downstate Health Sciences University, New York City, New York, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Tasneem F Mohammad
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
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6
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Funai K. Rare ashy dermatosis-like hyperpigmentation associated with osimertinib. Thorac Cancer 2022; 13:1436-1437. [PMID: 35348294 PMCID: PMC9058305 DOI: 10.1111/1759-7714.14383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022] Open
Abstract
Osimertinib, a third‐generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), is the most reliable EGFR‐TKI and is widely used as the first‐line treatment for EGFR mutation‐positive non‐small cell lung cancer. Pigmentary changes caused by EGFR‐TKIs are unusual, and to the best of my knowledge, hyperpigmentation with osimertinib has rarely been reported as a skin‐related adverse event. Here, I report a case of osimertinib‐associated ashy dermatosis‐like hyperpigmentation on imaging. Although reducing the dose of osimertinib to 40 mg did not improve pigmentation, osimertinib use was continued due to its clinical and radiological benefit, which persisted for a long time.
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Affiliation(s)
- Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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7
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Gupta MK, Lipner SR. Review of chemotherapy-associated paronychia. Int J Dermatol 2021; 61:410-415. [PMID: 34242408 DOI: 10.1111/ijd.15740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/18/2021] [Accepted: 05/28/2021] [Indexed: 12/01/2022]
Abstract
Chemotherapy-associated paronychia (CAP) is an inflammation of the nail folds in response to various chemotherapeutic medications. Altered proliferation of keratinocytes or nail matrix stem cells is thought to be a major causative factor. Prophylactic tetracyclines, topical povidone-iodine, and general irritation avoidance measures are among some of the recommended interventions for CAP. Appropriate recognition and treatment of CAP are important for prevention of chemotherapy dose reduction or medication discontinuation.
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Affiliation(s)
- Mohit K Gupta
- College of Medicine, State University of New York Downstate, Brooklyn, New York, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York City, New York, USA
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8
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Cosio T, Mazzilli S, Bianchi L, Campione E. The Dark Side of Gefitinib: Reflectance Confocal Microscopy Applied to Hair Hyperpigmentation. Skin Appendage Disord 2020; 6:44-47. [PMID: 32021862 DOI: 10.1159/000503758] [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: 08/09/2019] [Accepted: 09/26/2019] [Indexed: 11/19/2022] Open
Abstract
Gefitinib is a multi-target tyrosine kinase inhibitor used for the treatment of non-small cell lung cancer. Papulo-pustular and/or paronychia, abnormalities in hair growth, itching, and dryness due to epidermal growth factor inhibitors - i.e., PRIDE Complex - are a common effect of tyrosine kinase inhibitors. We report a case of hair and eyebrow hyperpigmentation after 7 months of treatment with gefitinib. In the literature, we found no data regarding rapid pigmentation of hair due to treatment with any multi-target tyrosine kinase inhibitors. To our knowledge, this is the first case reporting both hair and eyebrow hyperpigmentation. We hypothesize the role of different mechanisms linked to rapid hair hyperpigmentation.
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Affiliation(s)
- Terenzio Cosio
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sara Mazzilli
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luca Bianchi
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elena Campione
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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9
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Lertpichitkul P, Wititsuwannakul J, Asawanonda P, Rerknimitr P. Osimertinib-associated ashy dermatosis-like hyperpigmentation. JAAD Case Rep 2020; 6:86-88. [PMID: 32051836 PMCID: PMC7005333 DOI: 10.1016/j.jdcr.2019.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Pattamon Lertpichitkul
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Jade Wititsuwannakul
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Pravit Asawanonda
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Pawinee Rerknimitr
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
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10
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Ferreira MN, Ramseier JY, Leventhal JS. Dermatologic conditions in women receiving systemic cancer therapy. Int J Womens Dermatol 2019; 5:285-307. [PMID: 31909148 PMCID: PMC6938835 DOI: 10.1016/j.ijwd.2019.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/12/2019] [Accepted: 10/13/2019] [Indexed: 12/24/2022] Open
Abstract
As advances in cancer therapies have improved cancer-related survival, novel therapeutics have also introduced a variety of dermatologic toxicities, and an increased number of patients are living with these sequalae. Women with cancer in particular experience a spectrum of dermatologic conditions that affect their skin, hair, nail, and mucosal surfaces. Studies have shown that these toxic effects can significantly affect quality of life and alter a woman's self-image, cultural identity, femininity, sexuality, and mental health. In severe instances, dermatologic toxicities may even disrupt cancer therapy and can therefore affect overall survival and treatment response. In this article, we review the dermatologic adverse effects from traditional chemotherapy, targeted therapy, immune checkpoint inhibitors, and endocrine therapy that disproportionately affect women. The timely diagnosis and management of these dermatologic conditions is crucial in the multidisciplinary care of women with cancer.
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11
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Abstract
Drug-induced pigmentation accounts for up to 20% of all cases of acquired pigmentation. A thorough review of medical history and previous and ongoing medications as well as a complete skin examination can guide diagnosis. Implicated agents include alkylating/cytotoxic agents, analgesics, antiarrhythmics, anticoagulants, antiepileptics, antimalarials, antimicrobials, antiretrovirals, metals, prostaglandin analogs, and psychotropic agents, among others. Confirming true drug associations can be challenging, especially in the setting of delayed onset of pigmentation and coexisting polypharmacy.
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Affiliation(s)
- Amanda F Nahhas
- Department of Dermatology, Beaumont-Farmington Hills, Farmington Hills, MI, USA
- Department of Dermatology, Henry Ford Hospital, 3031 W. Grand Blvd., Suite 800, Detroit, MI, 48202, USA
| | - Taylor L Braunberger
- Department of Dermatology, Henry Ford Hospital, 3031 W. Grand Blvd., Suite 800, Detroit, MI, 48202, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Hospital, 3031 W. Grand Blvd., Suite 800, Detroit, MI, 48202, USA.
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13
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Dai J, Belum VR, Wu S, Sibaud V, Lacouture ME. Pigmentary changes in patients treated with targeted anticancer agents: A systematic review and meta-analysis. J Am Acad Dermatol 2017; 77:902-910.e2. [PMID: 28918974 DOI: 10.1016/j.jaad.2017.06.044] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/15/2017] [Accepted: 06/18/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND The discovery of signaling networks that drive oncogenic processes has led to the development of targeted anticancer agents. The burden of pigmentary adverse events from these drugs is unknown. OBJECTIVE To conduct a systematic review and meta-analysis of published clinical trials and determine the incidence and risk of development of targeted therapy-induced pigmentary changes. METHODS A comprehensive search was conducted to identify studies reporting targeted therapy-induced pigmentary changes. The incidence and relative risk were calculated. Case reports and series were reviewed to understand clinical characteristics. RESULTS A total of 8052 patients from 36 clinical trials were included. The calculated overall incidences of targeted cancer therapy-induced all-grade pigmentary changes in the skin and hair were 17.7% (95% confidence interval [CI], 11.9-25.4) and 21.5% (95% CI, 14.9-30.1), respectively. The relative risk of all-grade pigmentary changes of skin and hair were 93.7 (95% CI, 5.86-1497.164) and 20.1 (95% CI, 8.35-48.248). Across 53 case reports/series (N = 75 patients), epidermal growth factor receptor and breakpoint cluster region-abelson inhibitors were the most common offending agents. LIMITATIONS Potential under-reporting and variability in oncologists reporting these events. CONCLUSION There is a significant risk of development of pigmentary changes during treatment with targeted anticancer therapies. Appropriate counseling and management are critical to minimize psychosocial impairment and deterioration in quality of life.
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Affiliation(s)
- Julia Dai
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Stanford University, Stanford, California
| | - Viswanath R Belum
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shenhong Wu
- Division of Medical Oncology, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York; Division of Hematology and Oncology, Department of Medicine, Northport Veterans Administration Medical Center, Northport, New York
| | - Vincent Sibaud
- Department of Dermatology, Institut Claudius Regaud-Institut Universitaire du Cancer, Toulouse Oncopole, France
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Hsiue EHC, Lee JH, Lin CC, Yang JCH. Safety of gefitinib in non-small cell lung cancer treatment. Expert Opin Drug Saf 2016; 15:993-1000. [PMID: 27212579 DOI: 10.1080/14740338.2016.1192605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The development of EGFR TKI and the subsequent identification of activating EGFR mutations have dramatically changed how NSCLC is treated. With its recent approval by the US Food and Drug Administration, gefitinib adds to the list of recommended first-line treatments for lung cancer harboring EGFR mutations, which hitherto includes erlotinib and afatinib. AREAS COVERED This review summarizes the pharmacological property, clinical efficacy, and safety of gefitinib in major clinical trials and post-marketing studies. EXPERT OPINION Gefitinib is a well-tolerated treatment for advanced NSCLC. The most common adverse events are skin reaction and diarrhea, both of which are generally mild, noncumulative, and manageable. Other side effects such as interstitial lung disease and liver toxicity are less common but can be serious. Which EGFR TKI is the preferred first-line treatment is a matter of debate. Gefitinib and erlotinib have comparable efficacy, whereas afatinib may exert superior clinical activity over gefitinib. In terms of the most common toxicities of skin reaction and diarrhea, gefitinib may be the most tolerable of the three. Hence, despite being the earliest EGFR TKI developed, gefitinib continues to be one of the first-line treatments for advanced EGFR-mutated NSCLC, especially when skin and gastrointestinal toxicity is a concern.
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Affiliation(s)
| | - Jih-Hsiang Lee
- a Department of Oncology , National Taiwan University Hospital , Taipei , Taiwan.,b Department of Medical Research , National Taiwan University Hospital , Taipei , Taiwan.,c Graduate Institute of Oncology , National Taiwan University College of Medicine , Taipei , Taiwan.,d National Taiwan University Cancer Center , Taipei , Taiwan
| | - Chia-Chi Lin
- a Department of Oncology , National Taiwan University Hospital , Taipei , Taiwan.,c Graduate Institute of Oncology , National Taiwan University College of Medicine , Taipei , Taiwan.,d National Taiwan University Cancer Center , Taipei , Taiwan
| | - James Chih-Hsin Yang
- a Department of Oncology , National Taiwan University Hospital , Taipei , Taiwan.,b Department of Medical Research , National Taiwan University Hospital , Taipei , Taiwan.,c Graduate Institute of Oncology , National Taiwan University College of Medicine , Taipei , Taiwan.,d National Taiwan University Cancer Center , Taipei , Taiwan
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15
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Ferrazzi A, Russo I, Pasello G, Alaibac M. Atypical skin reaction in a patient treated with gefitinib for advanced lung cancer: A case report and review of the literature. Exp Ther Med 2015; 11:197-200. [PMID: 26889239 DOI: 10.3892/etm.2015.2881] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 10/14/2015] [Indexed: 11/06/2022] Open
Abstract
Gefitinib is a selective epidermal growth factor receptor tyrosine kinase inhibitor utilized for the treatment of advanced non-small cell lung carcinoma. The most commonly reported adverse event during gefitinib therapy is skin rash, particularly a papulopustular acne-like eruption. Cutaneous toxicities can affect treatment compliance and the quality of life of the patient. The present study reports a case of gefitinib-induced atypical skin reaction in a 73-year-old woman with advanced non-small cell lung cancer, who developed a squamous-crusted eruption on her face after 4 weeks of oral treatment with gefitinib at a dose of 250 mg/day. The patient was treated with 100 mg minocyclin (2 tablets/day, orally) and with ryfamicin topically. A complete resolution of the lesions was observed 2 weeks later. The present case report explored the pathogenesis of this skin manifestation, focusing on the underlying immunological mechanisms. A review of the literature concerning skin reactions to gefitinib was also conducted.
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Affiliation(s)
- Anna Ferrazzi
- Dermatology Unit, Department of Medicine, University of Padua, Padua I-35121, Italy
| | - Irene Russo
- Dermatology Unit, Department of Medicine, University of Padua, Padua I-35121, Italy
| | - Giulia Pasello
- Unit of Medical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua I-35128, Italy
| | - Mauro Alaibac
- Dermatology Unit, Department of Medicine, University of Padua, Padua I-35121, Italy
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16
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Macdonald JB, Macdonald B, Golitz LE, LoRusso P, Sekulic A. Cutaneous adverse effects of targeted therapies: Part I: Inhibitors of the cellular membrane. J Am Acad Dermatol 2015; 72:203-18; quiz 219-20. [PMID: 25592338 DOI: 10.1016/j.jaad.2014.07.032] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 12/18/2022]
Abstract
There has been a rapid emergence of numerous targeted agents in the oncology community in the last decade. This exciting paradigm shift in drug development lends promise for the future of individualized medicine. Given the pace of development and clinical deployment of targeted agents with novel mechanisms of action, dermatology providers may not be familiar with the full spectrum of associated skin-related toxicities. Cutaneous adverse effects are among the most frequently observed toxicities with many targeted agents, and their intensity can be dose-limiting or lead to therapy discontinuation. In light of the often life-saving nature of emerging oncotherapeutics, it is critical that dermatologists both understand the mechanisms and recognize clinical signs and symptoms of such toxicities in order to provide effective clinical management. Part I of this continuing medical education article will review in detail the potential skin-related adverse sequelae, the frequency of occurrence, and the implications associated with on- and off-target cutaneous toxicities of inhibitors acting at the cell membrane level, chiefly inhibitors of epidermal growth factor receptor, KIT, and BCR-ABL, angiogenesis, and multikinase inhibitors.
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Affiliation(s)
- James B Macdonald
- Department of Dermatology, Central Utah Clinic, Provo, Utah; Department of Pathology, Central Utah Clinic, Provo, Utah.
| | | | - Loren E Golitz
- Department of Dermatology, University of Colorado-Denver, Aurora, Colorado; Department of Pathology, University of Colorado-Denver, Aurora, Colorado
| | - Patricia LoRusso
- Department of Oncology, Wayne State University, Detroit, Michigan
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17
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Epidermal growth factor receptor inhibitors: a review of cutaneous adverse events and management. Dermatol Res Pract 2014; 2014:734249. [PMID: 24723942 PMCID: PMC3958662 DOI: 10.1155/2014/734249] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/23/2014] [Indexed: 12/14/2022] Open
Abstract
Epidermal growth factor inhibitors (EGFRI), the first targeted cancer therapy, are currently an essential treatment for many advance-stage epithelial cancers. These agents have the superior ability to target cancers cells and better safety profile compared to conventional chemotherapies. However, cutaneous adverse events are common due to the interference of epidermal growth factor receptor (EGFR) signaling in the skin. Cutaneous toxicities lead to poor compliance, drug cessation, and psychosocial discomfort. This paper summarizes the current knowledge concerning the presentation and management of skin toxicity from EGFRI. The common dermatologic adverse events are papulopustules and xerosis. Less common findings are paronychia, regulatory abnormalities of hair growth, maculopapular rash, mucositis, and postinflammatory hyperpigmentation. Radiation enhances EGFRI rash due to synergistic toxicity. There is a positive correlation between the occurrence and severity of cutaneous adverse effects and tumor response. To date, prophylactic systemic tetracycline and tetracycline class antibiotics have proven to be the most effective treatment regime.
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Lee SL, Tan BS, Chan LC. Paronychia induced by the epidermal growth factor receptor inhibitor cetuximab. J Oncol Pharm Pract 2012; 19:273-8. [PMID: 23161875 DOI: 10.1177/1078155212461289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While the development of epidermal growth factor receptor inhibitors has been hailed as a remarkable triumph in the field of oncology, it has inherited with it a host of cutaneous side-effects that have been increasingly observed in a substantial number of patients in the recent years. One cutaneous manifestation that may inflict significant pain and affect activities of daily living among some of the patients receiving epidermal growth factor receptor inhibitors is paronychia. A case of paronychia associated with the use of cetuximab in the management of KRAS wild-type midrectal adenocarcinoma along with its management has been described.
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Affiliation(s)
- Soo Lin Lee
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia.
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Garden BC, Wu S, Lacouture ME. The risk of nail changes with epidermal growth factor receptor inhibitors: A systematic review of the literature and meta-analysis. J Am Acad Dermatol 2012; 67:400-8. [DOI: 10.1016/j.jaad.2011.10.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 09/26/2011] [Accepted: 10/01/2011] [Indexed: 12/22/2022]
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20
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Fakih M, Vincent M. Adverse events associated with anti-EGFR therapies for the treatment of metastatic colorectal cancer. ACTA ACUST UNITED AC 2011; 17 Suppl 1:S18-30. [PMID: 20680104 PMCID: PMC2901793 DOI: 10.3747/co.v17is1.615] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The epidermal growth factor receptor (EGFR), a member of the ErbB family of receptor tyrosine kinases, plays an important role in the control of cell growth and differentiation. Disruption of its signaling leads to neoplastic cell proliferation, migration, stromal invasion, resistance to apoptosis, and angiogenesis. EGFR is overexpressed in a variety of solid tumors, including colorectal cancer (CRC), and its overexpression is associated with poorer prognosis. One class of agents that is currently used to target EGFR in the treatment of metastatic CRC (mCRC) is the monoclonal antibodies. While the monoclonal antibody EGFR inhibitors lack many of the severe side effects commonly observed with cytotoxic chemotherapy, they are associated with a set of unique dermatological toxicities. This paper reviews the safety profile of the anti-EGFR monoclonal antibodies cetuximab and panitumumab in the treatment of mCRC.
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Affiliation(s)
- M Fakih
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York.
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21
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Segaert S, Chiritescu G, Lemmens L, Dumon K, Van Cutsem E, Tejpar S. Skin toxicities of targeted therapies. Eur J Cancer 2009; 45 Suppl 1:295-308. [DOI: 10.1016/s0959-8049(09)70044-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Purpose. To provide a comprehensive literature review of chemotherapy-induced nail toxicity, including clinical presentation, implicated drugs and approaches for prevention and management. Data sources. A search of MEDLINE and EMBASE (1966—2008) databases was conducted using the terms (and variations of the terms) antineoplastic agents, nails, nail toxicity, onycholysis, and paronychia. Bibliographies from selected articles were reviewed for appropriate references. Data extraction. The retrieved literature was reviewed to include all articles relevant to the clinical presentation, diagnosis, incidence, prevention, and treatment of chemotherapy-induced nail toxicity. Data synthesis. Nail toxicity is a relatively uncommon adverse effect linked to a number of chemotherapeutic agents. Clinical presentation varies, depending on which nail structure is affected and the severity of the insult. Nail changes may involve all or some nails. Toxicity may be asymptomatic and limited to cosmetic concerns, however, more severe effects, involving pain and discomfort can occur. Taxanes and anthracyclines are the antineoplastic drug groups most commonly implicated. It is suggested that the administration schedule may influence the incidence of nail abnormalities, for example reported cases linked to the weekly administration of paclitaxel. Before instituting chemotherapy, patients should be educated regarding potential nail toxicities and strategies for prevention implemented. Management includes appropriate nail cutting, avoiding potential irritants, topical, or oral antimicrobials, and possibly cessation or dose reduction of the offending agent. Cryotherapy, through the application of frozen gloves or socks, has been beneficial in reducing docetaxel-induced nail toxicity and may be effective for other drugs. J Oncol Pharm Practice (2009) 15: 143—155.
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Affiliation(s)
- Peter Gilbar
- Department of Pharmacy, Toowoomba Health Services, PMB 2, Toowoomba, Australia,
| | - Alice Hain
- Department of Pharmacy, Toowoomba Health Services, PMB 2, Toowoomba, Australia
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Ricciardi S, Tomao S, de Marinis F. Toxicity of Targeted Therapy in Non–Small-Cell Lung Cancer Management. Clin Lung Cancer 2009; 10:28-35. [DOI: 10.3816/clc.2009.n.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Heidary N, Naik H, Burgin S. Chemotherapeutic agents and the skin: An update. J Am Acad Dermatol 2008; 58:545-70. [PMID: 18342708 DOI: 10.1016/j.jaad.2008.01.001] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 01/07/2008] [Accepted: 01/10/2008] [Indexed: 12/17/2022]
Abstract
UNLABELLED Chemotherapeutic agents give rise to numerous well described adverse effects that may affect the skin, hair, mucous membranes, or nails. The mucocutaneous effects of longstanding agents have been extensively studied and reviewed. Over the last 2 decades, a number of new molecular entities for the treatment of cancer have been approved by the United States Food and Drug Administration (FDA). This article reviews the cutaneous toxicity patterns of these agents. It also reviews one drug that has not received FDA approval but is in use outside the United States and is important dermatologically. Particular emphasis is placed on the novel signal transduction inhibitors as well as on newer literature pertaining to previously described reactions. LEARNING OBJECTIVES At the completion of this learning activity, participants should able to list the newer chemotherapeutic agents that possess significant mucocutaneous side effects and describe the range of reactions that are seen with each drug. In addition, they should be able to formulate appropriate management strategies for these reactions.
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Affiliation(s)
- Noushin Heidary
- Ronald O. Perelman Department of Dermatology, New York University, New York, USA
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25
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Bianchini D, Jayanth A, Chua YJ, Cunningham D. Epidermal growth factor receptor inhibitor-related skin toxicity: mechanisms, treatment, and its potential role as a predictive marker. Clin Colorectal Cancer 2008; 7:33-43. [PMID: 18279575 DOI: 10.3816/ccc.2008.n.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The human epidermal growth factor receptor (HER1/EGFR/ErbB1) signaling is aberrant and overexpressed in many solid malignancies making it an appealing target for biologic agents. Among the classes of drugs targeting EGFR are monoclonal antibodies and EGFR tyrosine kinase inhibitors, which have been shown effective and generally well tolerated in different clinical settings. The majority of patients treated with EGFR inhibitors (EGFRIs) develop specific dose-dependent skin toxicity. This side effect may lead to physical and psychosocial discomfort which can result in dose reduction or treatment interruption. The relationship between rash and clinical outcome has stimulated interest in this particular toxicity as a possible surrogate marker of efficacy in patients treated with targeted agents against EGFR. This review aims to summarize and update the current knowledge of the clinical presentation, predictive and prognostic value, and the management of EGFRI-related skin toxicity.
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Affiliation(s)
- Diletta Bianchini
- Department of Medicine, Royal Marsden Hospital, Down's Road, Sutton, Surrey, SM2 5PT UK
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26
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Doebelin B, Ly A, Allombert C, Faure M, Claudy A. Effets secondaires dermatologiques des inhibiteurs de l’EGFR. Presse Med 2008; 37:485-9. [PMID: 17601698 DOI: 10.1016/j.lpm.2007.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 04/27/2007] [Accepted: 05/23/2007] [Indexed: 11/23/2022] Open
Abstract
Epidermal growth cell receptors (EGFR) play a key role in tumor proliferation. Their inhibitors (anti-EGFR) are promising treatments for various types of cancers. Papulopustular follicular eruptions are the most frequent dermatological side effect and occur in 45 to 85% of patients receiving this treatment. Paronychias appear after several weeks of treatment. They are painful and impair hand and foot function. A positive correlation seems to exist between the intensity of the papulo-follicular eruption, tumor regression and survival.
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27
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Hammond-Thelin LA. Cutaneous reactions related to systemic immunomodulators and targeted therapeutics. Dermatol Clin 2008; 26:121-59, ix. [PMID: 18023775 DOI: 10.1016/j.det.2007.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The arrival of targeted therapeutics into the oncology clinic, while enthusiastically anticipated, introduced the oncologist to dermatologic events that can pose challenging management issues. The dermatologic effects of these targeted agents appear to be more frequent than those with cytotoxic therapy and are not uniform; that is, different agents have distinct dermatologic toxicities. Interestingly, dermatologic toxicity may correlate with antitumor activity with some of these targeted agents. The correlation of rash with response and survival in particular mandates the development of effective and appropriate management strategies. The nature and challenges of the dermatologic events observed to date with epidermal growth factor receptor inhibitors, multikinase inhibitors, proteosome inhibitors, BCR-ABL tyrosine kinase inhibitors, and immunomodulatory drugs will be addressed in this review.
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28
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Hinds G, Thomas VD. Malignancy and Cancer Treatment-Related Hair and Nail Changes. Dermatol Clin 2008; 26:59-68, viii. [DOI: 10.1016/j.det.2007.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Fernández-Guarino M, Garrido López P, González-García C, Jaén P. [Erlotinib (Tarceva) induced severe exanthema]. Rev Clin Esp 2007; 207:422-3. [PMID: 17688875 DOI: 10.1157/13108767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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30
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Fox LP. Nail toxicity associated with epidermal growth factor receptor inhibitor therapy. J Am Acad Dermatol 2007; 56:460-5. [PMID: 17147969 DOI: 10.1016/j.jaad.2006.09.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 09/12/2006] [Accepted: 09/18/2006] [Indexed: 10/23/2022]
Abstract
As the use of epidermal growth factor receptor inhibitors becomes more widespread, increasing data are being collected regarding both efficacy and toxicity. Cutaneous toxicities are emerging not only as the most relevant class-related events, but also as potentially important markers of response to therapy. Although a follicular eruption is the most frequent cutaneous manifestation of epidermal growth factor receptor inhibition, ingrown nails, paronychia, and xerosis and desquamation of the digits, all of which occur in a substantial number of patients, require attention from treating oncologists and dermatologists. These nail disorders are mostly mild to moderate in severity, but, if not properly managed, can result in significant pain and interfere with activities of daily living. Descriptions of the nail and periungual toxicities associated with epidermal growth factor receptor inhibitor therapy and prevention and treatment strategies are presented.
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Affiliation(s)
- Lindy P Fox
- Department of Dermatology, University of California, San Francisco, CA 94143, USA.
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31
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Galimont-Collen AFS, Vos LE, Lavrijsen APM, Ouwerkerk J, Gelderblom H. Classification and management of skin, hair, nail and mucosal side-effects of epidermal growth factor receptor (EGFR) inhibitors. Eur J Cancer 2007; 43:845-51. [PMID: 17289377 DOI: 10.1016/j.ejca.2006.11.016] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 11/27/2006] [Indexed: 01/26/2023]
Abstract
Inhibitors of epidermal growth factor receptor (EGFR) are commonly used as therapeutic agents in oncology. In contrast to currently used oncological treatments, these inhibitors almost always cause skin- and skin adnex toxicity. About 85% of treated patients develop to a more or lesser extent an acneiform eruption. Xerosis cutis and painful nail disorders occur in, respectively, 35% and 10-15% of all treated patients. Also hair and mucosal changes have been reported, although to a lesser extent. These skin- and skin adnex toxicities are reversible after withdrawal of treatment, but are seldom a reason to stop or interrupt therapy. This review outlines the classification, the pathogenesis and therapy of these skin, hair, nail and mucosal changes due to EGFR inhibition. Informing the patient and management of these side-effects is very important to reduce discomfort and as such to increase compliance to therapy.
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Affiliation(s)
- A F S Galimont-Collen
- Department of Dermatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
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32
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33
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Lacouture ME, Boerner SA, Lorusso PM. Non-Rash Skin Toxicities Associated with Novel Targeted Therapies. Clin Lung Cancer 2006; 8 Suppl 1:S36-42. [PMID: 17239289 DOI: 10.3816/clc.2006.s.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Many novel targeted agents have emerged against a variety of malignancies. Although papulopustular rash is the most commonly observed side effect associated with many of these agents, several non-rash skin toxicities have been identified that frequently result in the delay or discontinuation of anticancer therapy. These toxicities include skin hyperpigmentation, xerosis, pruritus, hair growth and color abnormalities, periungual and nail alterations, and hand-foot skin reaction. It is important to recognize these toxicities, so that they can be diagnosed early and treatment or dose modification can be initiated, if necessary. This review discusses several non-rash dermatologic toxicities observed with targeted therapeutic agents and guidelines for their diagnosis and treatment.
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Affiliation(s)
- Mario E Lacouture
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 48201, USA
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34
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Hu JC, Sadeghi P, Pinter-Brown LC, Yashar S, Chiu MW. Cutaneous side effects of epidermal growth factor receptor inhibitors: clinical presentation, pathogenesis, and management. J Am Acad Dermatol 2006; 56:317-26. [PMID: 17141360 DOI: 10.1016/j.jaad.2006.09.005] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 09/05/2006] [Accepted: 09/06/2006] [Indexed: 10/23/2022]
Abstract
The growing investigation and use of epidermal growth factor receptor (EGFR) inhibitors in anticancer therapy has been motivated by their specificity for EGFR, which improves their ability to target cancer cells and enhances their safety profile compared with many other conventional chemotherapeutic agents. However, their growing use has been accompanied by an increasing incidence of cutaneous toxicities, which can cause serious discomfort and be disabling. This review illustrates the common cutaneous side effects seen in patients receiving EGFR inhibitors and discusses various options for management. With effective management of these side effects, dermatologists can play an integral role in facilitating compliance with anti-EGFR therapy and aid with effective oncologic management.
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Affiliation(s)
- Jenny C Hu
- David Geffen School of Medicine at University of California, Los Angeles 90095, USA
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35
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Fernández-Guarino M, Aldanondo I, González-García C, Garrido P, Marquet A, Pérez-García B, Jaén P. [Gefitinib-induced perforating dermatosis]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:208-11. [PMID: 16796971 DOI: 10.1016/s0001-7310(06)73383-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Gefitinib (Iressa) is a new antineoplastic agent that acts by selectively inhibiting epidermal growth factor receptor tyrosine kinase (EGFR-TK). It has shown activity against several solid tumors. Because of their action mechanism, gefitinib and other tyrosine kinase inhibitors have been associated with multiple cutaneous effects, most of which are mild and well tolerated. We present a case of perforating dermatosis after treatment with gefitinib.
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Abstract
The increased target specificity of epidermal growth factor receptor (EGFR) inhibitors (EGFRIs) is associated with the reduction or abolition of nonspecific and haematopoietic side effects. However, coincident inhibition of receptor activity in tissues that depend on EGFR signalling for normal function has undesirable consequences. Because of the key role of EGFR signalling in skin, dermatological toxicities have frequently been described with EGFRIs. The resultant significant physical and psycho-social discomfort might lead to interruption or dose modification of anticancer agents. There is an urgent need for an improved understanding of these toxicities to develop adequate staging systems and mechanistically driven therapies, and to ensure quality of life and consistent antineoplastic therapy.
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Affiliation(s)
- Mario E Lacouture
- SERIES Clinic and Cancer Skin Care Program, Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Suite 1600, Chicago, Illinois 60611, USA.
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37
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Chang GC, Tsai CM, Chen KC, Yu CJ, Shih JY, Yang TY, Lin CP, Hsu JY, Chiu CH, Perng RP, Yang PC, Yang CH. Predictive Factors of Gefitinib Antitumor Activity in East Asian Advanced Non-small Cell Lung Cancer Patients. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)30353-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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38
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Mottet N, Prayer-Galetti T, Hammerer P, Kattan MW, Tunn U. Optimizing outcomes and quality of life in the hormonal treatment of prostate cancer. BJU Int 2006; 98:20-7. [PMID: 16566812 DOI: 10.1111/j.1464-410x.2006.06176.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We review the effectiveness of androgen-deprivation therapy (ADT) in the management of prostate cancer, and the effect that this treatment has on a patient's quality of life (QoL), based on discussions held at a European symposium on the management of prostate cancer. The overall QoL is reduced in asymptomatic men, and there are known decreases in cognitive function, self-esteem, libido and sexual function. Hot flashes are also a frequent problem. Prolonged ADT can lead to osteoporosis and subsequently fractures. Various effective methods exist to manage and minimize these side-effects; some are specific to the side-effect, whereas other more general methods include lifestyle changes, specific drugs and added hormonal manipulations. Intermittent ADT for patients taking luteinizing hormone-releasing hormone agonists offers a promising method to reduce adverse effects, and possibly increases the time to androgen independence. Initial studies indicate that prostate-specific antigen-based progression with intermittent ADT is similar to that seen with continuous ADT, but there is a reduction in side-effects, leading to an improvement in QoL.
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Affiliation(s)
- Nicolas Mottet
- Department of Urology, Clinique Mutualiste, St Etienne, France.
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39
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Predictive Factors of Gefitinib Antitumor Activity in East Asian Advanced Non-small Cell Lung Cancer Patients. J Thorac Oncol 2006. [DOI: 10.1097/01243894-200607000-00004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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40
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Guhl G, González-de Arriba A, Daudén E. Efectos cutáneos de los inhibidores del receptor del factor de crecimiento epidérmico. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:296-310. [PMID: 16956561 DOI: 10.1016/s0001-7310(06)73407-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Epidermal growth factor receptor (EGFR) inhibitors are a new group of drugs used in the treatment of several malignancies. Three molecules are approved at the moment: gefitinib and erlotinib for the treatment of non-small-cell lung cancer, and cetuximab for colorectal cancer. These drugs originate cutaneous side effects with a high frequency: acneiform rashes, paronychia and generalized xerodermia. In this paper we review these common side effects and how to manage them.
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Affiliation(s)
- Guillermo Guhl
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España.
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41
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Abstract
Gefitinib, an epidermal growth factor receptor inhibitor, is currently approved for use in patients with advanced non-small cell lung cancer who have failed previous chemotherapy or who are not suitable for chemotherapy in > 30 countries. The approved dose in patients with non-small cell lung cancer is 250 mg/day. The most common adverse effects are rash, diarrhoea, acne, dry skin, nausea and vomiting. Most of the effects are mild-to-moderate in nature and do not require discontinuation of therapy. The severity of many of these effects is dose-related with grade 3-4 effects more likely at a dose > 250 mg/day. The most severe adverse effect is interstitial lung disease (ILD), which occurs in approximately 1% of patients worldwide except for Japan where the incidence of ILD is 2%. ILD is fatal in approximately one out of three of the cases. The most common adverse effects associated with chemotherapy, myelosuppression and alopecia, are not commonly seen with gefitinib monotherapy.
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42
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Shu KY, Kindler HL, Medenica M, Lacouture M. Doxycycline for the treatment of paronychia induced by the epidermal growth factor receptor inhibitor cetuximab. Br J Dermatol 2005; 154:191-2. [PMID: 16403122 DOI: 10.1111/j.1365-2133.2005.07010.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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43
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Managing cutaneous side effects of epidermal growth factor receptor (HER1/EGFR) inhibitors. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s1548-5315(11)70630-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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44
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Martínez de Lagrán Z, Ratón JA, Lasa O, Acebo E, Díaz-Pérez JL. Erupción acneiforme por inhibidores del receptor de crecimiento epidérmico. ACTAS DERMO-SIFILIOGRAFICAS 2005; 96:450-4. [PMID: 16476273 DOI: 10.1016/s0001-7310(05)73110-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
One of the fundamental aims of oncological research is the search for molecules with greater efficacy against tumors and less toxicity than the usual chemotherapeutic agents. Epidermal growth factor receptor inhibitors are a new group of drugs which, because of their more specific effect against neoplastic cells, seem to meet these characteristics. Skin eruptions are one of the most frequent adverse effects associated with their use, secondary to the drug's direct inhibitory effect on homeostasis of the epidermis and of the pilosebaceous follicle. Several cases of cutaneous toxicity in patients treated with epidermal growth factor receptor inhibitors have recently been published. We present three cases of acneiform eruptions attributable to different drugs in this family (cetuximab, gefitinib and erlotinib).
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45
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Segaert S, Van Cutsem E. Clinical signs, pathophysiology and management of skin toxicity during therapy with epidermal growth factor receptor inhibitors. Ann Oncol 2005; 16:1425-33. [PMID: 16012181 DOI: 10.1093/annonc/mdi279] [Citation(s) in RCA: 366] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The last few years, new therapies targeting the epidermal growth factor receptor (EGFR) have shown their efficacy in the treatment of several types of cancer. Monoclonal antibodies against the EGFR (e.g. cetuximab, panitumumab) or EGFR tyrosine kinase inhibitors (e.g. gefitinib, erlotinib) are generally well tolerated and do not have the severe systemic side-effects usually seen with cytotoxic drugs. A considerable number of patients treated with these EGFR inhibitors, however, develop dermatological side-effects, most frequently an acneiform eruption but also xerosis, eczema, fissures, telangiectasia, hyperpigmentation, hair changes and paronychia with pyogenic granuloma. These skin effects appear to be mechanism-based linked to the inhibition of EGFR action but the exact pathophysiology remains elusive. Left untreated these dermatological side-effects could represent a threat to patient compliance. Therefore effective management is mandatory. Mild cases of acneiform eruption respond well to topical anti-inflammatory acne therapy, whereas tetracyclines are needed to treat moderate to severe cases. This review outlines the broad spectrum of cutaneous side-effects of EGFR inhibitors, discusses possible underlying mechanisms and provides practical guidelines for the management based on literature data and on personal experience.
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Affiliation(s)
- S Segaert
- Department of Dermatology, University Hospital, Katholieke Universiteit Leuven, Belgium
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Shuster J. Heparin-Induced Thrombocytopenia; Hepatotoxicity with Newer Diabetes Agent; Acute Myocardial Infarction Associated with Albuterol; Olanzapine-Induced Hyperglycemic Hyperosmolar Nonketotic Coma; Paronychia and Skin Hyperpigmentation Due to Gefitinib; Selective Serotonin Reuptake Inhibitor-Induced Enuresis; Do Antidepressants Confer a Decreased Risk for Myocardial Infarction?; Recent Adverse Event Reviews; An Online Interview Discussing the Reduction of ADRs. Hosp Pharm 2005. [DOI: 10.1177/001857870504000103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
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Affiliation(s)
- Joel Shuster
- Temple University School of Pharmacy, Philadelphia, PA; Clinical Pharmacist, Episcopal Hospital, Philadelphia
- Clinical Advisor and Trustee, Institute for Safe Medication Practices, Huntingdon Valley, PA 19006
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