Prophylactic creams and antibiotics reduce severe drug-related skin rash

1 Jun 2009

A randomised study, presented at the American Society of Clinical Oncology annual meeting, has shown that giving patients a combination regimen consisting of moisturisers, sunscreen, topical corticosteroids and oral antibiotics before they receive panitumumab (Vectibix) reduces the incidence of a severe skin rash by more than half and has a significant impact on patients’ quality of life, and decreases delays in receiving therapy, which could potentially impact cancer outcomes. Panitumumab belongs to a class of drugs known as epidermal growth factor receptor (EGFR) inhibitors.

"The skin toxicity caused by EGFRs like panitumumab and cetuximab can be devastating for patients. It prevents many patients from agreeing to take these drugs and either delays or interrupts treatment for many others, reducing the effectiveness of therapy," explained Dr. Edith Mitchell, clinical professor of medicine and medical oncology at Thomas Jefferson University in Philadelphia and the study’s lead author. "Prophylactic skin treatment is likely to become a new standard of care for patients receiving these drugs."

About 90 per cent of patients receiving panitumumab and up to 75 per cent of those who take cetuximab (Erbitux) develop a significant acne-like rash that is not only cosmetically unattractive, but can lead to serious skin infections causing delays in treatment. The rash develops because these drugs target the epidermal growth factor receptor, which is found in very high amounts in the skin.

In this study, skin toxicity was compared between 48 patients with metastatic colorectal cancer who were randomly assigned to receive prophylactic skin treatment (moisturisers, sunscreen, topical steroids and the antibiotic doxycycline) for six weeks starting 24 hours before panitumumab-based therapy and 47 patients whose skin was not treated until after the rash developed.

Twenty-nine per cent of those in the prophylactic group experienced skin toxicity versus 62 per cent of those in the delayed treatment group. Patients who received the prophylactic skin treatment also reported better quality of life than those whose rash was not treated until after it developed because they felt better about their appearance and were more physically comfortable, with less impairment of their lifestyle.