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PROPHYLACTIC EFFECT OF NITRIC OXIDE DONORS ON RAT MODELS OF EGFR INHIBITORS-INDUCED CUTANEOUS TOXICITIES. J Invest Dermatol 2022; 142:3052-3061.e8. [PMID: 35618045 DOI: 10.1016/j.jid.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 11/20/2022]
Abstract
Epidermal growth factor receptor inhibitors (EGFRIs) have been established as first-line standard-of-care therapies for non-small cell lung cancer (NSCLC) but are frequently accompanied by adverse dermatological effects, in particular, acneiform rash. There is no effective clinical intervention, partially because of its poorly understood etiology. Here, we show that inhibition of EGFR initiated keratinocyte HaCaT cell cycle arrest and apoptosis, which fueled a robust secondary inflammatory response. Rats gavaged with EGFRI showed a phenotype similar to that of clinical patients, which was in line with the interrupted functions observed in HaCaT keratinocytes. We found that a nitric oxide (NO) donor, nitroglycerin (GTN), was a feasible treatment alternative for EGFRI-induced rash. Restoration of epidermal extracellular signal-regulated kinase (ERK) and a reduction in STAT3 signaling via GTN treatment rescued the cellular functions that had been damaged in vitro and further ameliorated the rash in rat models. In addition, the efficacy of GTN was superior to that of existing clinical interventions. These data highlighted the importance of epidermal EGFR signaling and led to the identification of a small-molecule NO donor as a mediator that can maintain EGFR pathway functions during anti-EGFR therapies, providing a therapeutic anchor point for adverse EGFRI-induced skin effects.
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Byun HJ, Lee HJ, Yang JI, Kim KH, Park KO, Park SM, Lee KE, Choi J, Noh DY, Cho KH. Daily skin care habits and the risk of skin eruptions and symptoms in cancer patients. Ann Oncol 2012; 23:1992-1998. [PMID: 22700992 DOI: 10.1093/annonc/mds141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Cancer patients are at high risk for skin problems because rapidly proliferating skin cells are susceptible to anticancer therapies. However, the effects of daily skin care habits on development of skin problems in cancer patients have rarely been studied. PATIENTS AND METHODS We conducted a survey of daily skin care habits and the presence of skin problems in 866 cancer patients. RESULTS Hot water bath>1 h significantly increased the risk of definite eruptions [odds ratio (OR) 4.09] and the risk of itching or pain on the skin (OR 1.73). Diligent use of moisturizers did not decrease the risk of definite eruptions and symptoms, and daily bathing, scrubbing off the skin while bathing, and sun protection did not influence the risk of definite eruptions and symptoms. Subgroup analysis of 183 breast cancer patients showed results similar to the total results, including that hot water bath>1 h significantly increased the risk of definite eruptions (OR 3.41). CONCLUSIONS Being a cross-sectional study, our study could not prove causality. However, at the present stage of knowledge, avoidance of hot water baths of protracted duration should be first emphasized in patient education to prevent skin problems in cancer patients.
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Affiliation(s)
- H J Byun
- Skin Cancer/Chemotherapy Skin Care Center, Seoul National University Cancer Hospital, Seoul; Department of Dermatology, Seoul, National University College of Medicine, Seoul; Institute of Dermatological Science, Medical Research Center, Seoul National University, Seoul
| | - H J Lee
- Gastric Cancer Center, Seoul National University Cancer Hospital, Seoul; Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul.
| | - J I Yang
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Gangnam Healthcare Center, Seoul
| | - K H Kim
- Skin Cancer/Chemotherapy Skin Care Center, Seoul National University Cancer Hospital, Seoul; Department of Dermatology, Seoul, National University College of Medicine, Seoul; Institute of Dermatological Science, Medical Research Center, Seoul National University, Seoul
| | - K O Park
- Center for Cancer Education and Information, Seoul National University Cancer Hospital and Department of Nursing, Seoul National University Hospital, Seoul
| | - S M Park
- Center for Cancer Education and Information, Seoul National University Cancer Hospital and Department of Nursing, Seoul National University Hospital, Seoul; Department of Family Medicine, Seoul National University College of Medicine, Seoul
| | - K E Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul; Thyroid Cancer Center, Seoul National University Cancer Hospital, Seoul
| | - J Choi
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul
| | - D-Y Noh
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul; Breast Cancer Center, Seoul National University Cancer Hospital, Seoul, South Korea
| | - K H Cho
- Skin Cancer/Chemotherapy Skin Care Center, Seoul National University Cancer Hospital, Seoul; Department of Dermatology, Seoul, National University College of Medicine, Seoul; Institute of Dermatological Science, Medical Research Center, Seoul National University, Seoul.
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Scandurra G, Aiello RA, Alì M, Taibi E, Sanò MV, Todaro FM, La Rocca R, Licciardello P, Caruso M. Appropriate management of cutaneous adverse events maximizes compliance with sorafenib treatment: a single-center experience. Future Oncol 2012; 8:609-15. [DOI: 10.2217/fon.12.35] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aims: This report describes a positive experience of adverse event (AE) management of a multidisciplinary clinical team and 18 patients with late-stage renal cell carcinoma and hepatocellular carcinoma attending the Day Hospital Unit of the ‘Centro Catanese di Oncologia Humanitas’ (Italy) over a 2-year period. Methods: The management strategy was based on preventive measures for reducing the development of cutaneous AEs, including pain, risk of infection and patient discomfort, while avoiding the discontinuation or the reduction of the sorafenib dosage. Results: As of July 2011, eight patients were still under treatment with sorafenib; seven patients experienced cutaneous AEs and two reported severe cutaneous AEs. Conclusion: Our treatment approach seemed to reduce the incidence and/or severity of AEs, keeping patients in treatment, which is essential for good treatment outcomes.
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Affiliation(s)
- Giuseppa Scandurra
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Rosa Anna Aiello
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Marco Alì
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Eleonora Taibi
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Maria Vita Sanò
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Francesco Maurizio Todaro
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Rosaria La Rocca
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Paolo Licciardello
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Michele Caruso
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
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Bachet JB, Peuvrel L, Bachmeyer C, Reguiai Z, Gourraud PA, Bouché O, Ychou M, Bensadoun RJ, Dreno B, André T. Folliculitis induced by EGFR inhibitors, preventive and curative efficacy of tetracyclines in the management and incidence rates according to the type of EGFR inhibitor administered: a systematic literature review. Oncologist 2012; 17:555-68. [PMID: 22426526 DOI: 10.1634/theoncologist.2011-0365] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Folliculitis is the most common side effect of epidermal growth factor receptor (EGFR) inhibitors (EGFRIs). It is often apparent, altering patients' quality of life and possibly impacting compliance. Variations in terms of the treatment-related incidence and intensity have not been fully elucidated. Tetracyclines have been recommended for the prophylaxis and treatment of folliculitis but their efficacy is yet to be established. MATERIALS AND METHODS We carried out two systematic literature reviews. The first assessed the preventive and curative efficacy of tetracyclines. The second assessed the incidence of grade 3-4 folliculitis in the main clinical studies published. RESULTS In four randomized studies, preventive tetracycline treatment was associated with a significantly lower incidence of grade 2-3 folliculitis and a better quality of life in three of the four studies. In curative terms, tetracycline efficacy was not evaluated in any randomized study, but an improvement in grade ≥2 folliculitis was reported in case series. The frequency and severity of folliculitis seem to be greater with the antibodies than with the tyrosine kinase inhibitors. Analysis restricted to lung cancer studies showed a statistically greater incidence in terms of grade 3-4 folliculitis with cetuximab (9%) and erlotinib (8%) than with gefitinib (2%) (p < .0001). CONCLUSION Unless contraindicated, a tetracycline should be routinely prescribed prophylactically for patients treated with an EGFRI (level of evidence, B2). In curative therapy, the level of evidence for tetracycline efficacy is low (level of evidence, D). The incidence of grade 3-4 folliculitis induced by EGFRIs appears to be lower with gefitinib.
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Affiliation(s)
- Jean-Baptiste Bachet
- Department of Hepato-Gastro-Enterology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre & Marie Curie, Paris, France
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Cohen PR, Escudier SM, Kurzrock R. Cetuximab-associated elongation of the eyelashes: case report and review of eyelash trichomegaly secondary to epidermal growth factor receptor inhibitors. Am J Clin Dermatol 2011; 12:63-7. [PMID: 20726623 DOI: 10.2165/11531920-000000000-00000] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Eyelash trichomegaly is an uncommon drug-associated sequelae experienced during treatment with epidermal growth factor receptor (EGFR) inhibitors. Elongation of the eyelashes induced by these agents has predominantly been observed in oncology patients with either colorectal or lung cancer. It is most frequently associated with cetuximab and erlotinib; however, it has also been described in individuals treated with gefitinib or panitumumab. We describe cetuximab-associated eyelash trichomegaly in a woman with metastatic rectal carcinoma. We review the clinical presentation, adverse effects, and management of EGFR inhibitor-related eyelash trichomegaly. The long eyelashes are not a drug-limiting adverse effect and some patients consider the change to be cosmetically enhancing. Trimming the lashes with scissors can usually ameliorate local symptoms. The eyelashes often return to their original length at variable time periods after EGFR inhibitor therapy is discontinued.
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Affiliation(s)
- Philip R Cohen
- The University of Houston Health Center, University of Houston, Texas, USA.
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A randomized phase II study of raltitrexed and gefitinib versus raltitrexed alone as second line chemotherapy in patients with colorectal cancer. (1839IL/0143). Invest New Drugs 2010; 29:1038-44. [DOI: 10.1007/s10637-010-9400-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 02/01/2010] [Indexed: 10/19/2022]
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Wauters O, Sabatiello M, Nikkels-Tassoudji N, Choffray A, Richert B, Piérard GE, Nikkels A. Le botryomycome. Ann Dermatol Venereol 2010; 137:238-42, quiz 237, 243. [DOI: 10.1016/j.annder.2009.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 09/23/2009] [Indexed: 12/11/2022]
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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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Hoag JB, Azizi A, Doherty TJ, Lu J, Willis RE, Lund ME. Association of cetuximab with adverse pulmonary events in cancer patients: a comprehensive review. J Exp Clin Cancer Res 2009; 28:113. [PMID: 19682368 PMCID: PMC2735734 DOI: 10.1186/1756-9966-28-113] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 08/14/2009] [Indexed: 12/16/2022] Open
Abstract
Compounds derived from biologic sources, or biologicals, are increasingly utilized as therapeutic agents in malignancy. Development of anti-cancer targeted therapies from biologics is increasingly being utilized. Cetuximab, a chimeric monoclonal antibody, is one such anti-cancer targeted therapeutic that has shown efficacy in quelling the rate of patient decline in colorectal, head/neck, and non-small cell lung cancer. However, due to the relatively recent addition of biologic compounds to the therapeutic arsenal, information related to adverse reactions is less well known than those seen in traditional chemotherapeutics. Dermatologic reactions have been demonstrated as the most frequent side effect cited during cetuximab therapy for malignancy; however, other effects may lead to greater morbidity. In general, pulmonary complications of therapeutics can lead to significant morbidity and mortality. The purpose of this review is to compile the various pulmonary side effects seen in patients treated with cetuximab for various malignancies, and to compare the incidence of these adverse reactions to standard therapies.
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Affiliation(s)
- Jeffrey B Hoag
- Cancer Treatment Centers of America, Eastern Regional Medical Center, Philadelphia, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Aimel Azizi
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Jason Lu
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Rudolph E Willis
- Cancer Treatment Centers of America, Eastern Regional Medical Center, Philadelphia, PA, USA
| | - Mark E Lund
- Cancer Treatment Centers of America, Eastern Regional Medical Center, Philadelphia, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
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Mishra B, Praharaj SK, Prakash R, Sinha VK. Aripiprazole-induced acneiform eruption. Gen Hosp Psychiatry 2008; 30:479-81. [PMID: 18774434 DOI: 10.1016/j.genhosppsych.2008.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2007] [Revised: 02/17/2008] [Accepted: 02/20/2008] [Indexed: 11/18/2022]
Abstract
Drug-induced acneiform eruptions are inflammatory follicular reactions that resemble acne vulgaris both in morphology and distribution, which manifest clinically as papulopustules and occasionally as comedones. We report a case of a patient who developed acneiform eruptions while being treated with aripiprazole which resolved after discontinuation of aripiprazole and application of topical retinoic acid. The acneiform eruption could be explained on the basis of Type III allergic mechanism in an already sensitized individual.
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