A survey study of prevention and treatment patterns by academic and community oncologists for papulopustular, acneiform skin rash associated with epidermal growth factor receptor inhibitor (EGFRi) therapy.
Authors: Lacouture Mario E. , Anadkat Milan J. , Patel Anisha B , Marathe Omkar Subhash , Webb Mark L , Tyler Robert Claude , Chen Liping , Wu Chengguang , Li Wenxi , Ju Juegang , Luo Jie , Tang Hong , Vogelzang Nicholas J. 
Published: June 2022

e24083

Background: EGFRi’s are associated with dermatologic AEs that include an acneiform skin rash. This rash occurs in up to 80% for all grades and 18% for grades ≥3. Treatments are based on grade and include topical antibiotics or corticosteroids for grades 1 and 2, and EGFRi dose interruption and/or oral corticosteroids for severe grades (i.e., ≥ grade 3). For prevention, topical corticosteroids or oral antibiotics are recommended. This survey was conducted to assess current toxicity management patterns and treatment gaps for EGFRi associated skin rash. Methods: An online survey (MedSurvey) with 5 eligibility & 8 questions related to EGFRi practice patterns was conducted (April 2021). Fifty-one practicing oncologists completed the survey. Results: Among the 51 oncologists, 86% have been practicing ≥ 11 yrs with 37% from an academic and 63% from a community setting. They (percent of respondents) prescribed cytotoxic chemotherapy (91%) and targeted agents (84%) > 10x/week. Prevention of EGFRi skin rash with topical antibiotics (33%), topical steroids (45%), and oral antibiotics (45%) were commonly administered prophylactic treatments, while 26% do not treat prophylactically. EGFRi’s were started at a lower dose always 6%, frequently (≥50%) 26%, sometimes (< 50%) 24%, and never 45% of the time. Skin rash treatment is started by 47% at Grade 1, 33% at Grade 2, and 2% ≥Grade 3, while 18% start treatment prophylactically. The majority (57%) would use a novel agent to treat skin rash, while 26% would use it for patients with a previous occurrence, 13% for those not responding to the standard of care and 2% would use this agent for selected EGFR inhibitors. For Grade 1 skin rash (multiple choices allowed), 33% used observation only for management, whereas 55% prescribed topical antibiotics, 35% prescribed oral antibiotics, and 55% used topical steroids. Dose reduction was implemented 4% of the time. For Grade 2 skin rash (multiple choices allowed) 51% used topical antibiotics, 63% prescribed an oral antibiotic, and 77% used topical steroids. Dose reduction was used 35% of the time. For patients not responding to standard therapy 6% switched to a different anti-cancer regimen, 16% changed to another EGFRi, while 77% interrupted the EGFRi therapy. Conclusions: Treating EGFRi-associated skin rash continues to be a significant challenge with Grade 2/3 toxicity or patients not responding to standard treatment. This often requires a therapeutic dose reduction or interruption that may impact the efficacy of anti-cancer treatment. Effective management (prevention and treatment) for skin toxicities associated with EGFRi inhibitors remains an unmet need for many patients and a treatment challenge for oncologists.