Management of dermatologic toxicities associated with monoclonal antibody epidermal growth factor receptor inhibitors: A case review
A 75-year-old man was switched to a new line tumor therapy with panitumumab (Vectibix® - Amgen Europe B.V.) (6 mg/kg of bodyweight given once every 2 weeks) for the treatment of EGFR-expressing mCRC (stage IV) with KRAS wild-type, after failure of the following chemotherapy regimens: capecitabine/oxaliplatin, capecitabine/irinotecan, capecitabine/oxaliplatin/bevacizumab, capecitabine/bevacizumab.\nThe patient had no history of severe or life-threatening hypersensitivity to panitumumab and its excipients.\nOn the morning of October 30th, 2012, he was admitted to the oncology outpatient service to receive his first infusion of panitumumab (520 mg given once every 2 weeks). His skin was healthy and the drug was well-tolerated.\nSeveral hours after initial drug infusion, he developed a pruritic, erythematous eruption over anterior chest and face. Over the time, the skin reaction worsened; but the patient was not treated with any drug. Two weeks after starting panitumumab treatment and before the second infusion, the patient reported to his oncologist an intense, pruritic, skin eruption that was appeared on the face [], scalp, neck and upper chest. Therefore, he was referred to a dermatologist for an in-depth clinical evaluation. Physical examination revealed wide erythematous areas almost entirely covered by crusted papulopustular and pustular necrotic lesions.\nExcluding any drug-drug interactions (DDIs), a diagnosis of panitumumab-induced Grade 3B papulopustular skin rash, according to NCI-CTCAE v4.0, was made. Hence, the oncologist delayed the subsequent panitumumab dose until the severity of rash was reduced to at least Grade 2 and recommended a treatment with oral levofloxacin (500 mg once daily for 5 days), topical hydrocortisone 0.1% (cream: twice daily application for 5 days) and methylprednisolone 0.1% (cream: once daily application for 5 days).\nTwo weeks later, the severity of skin symptoms reduced to Grade 2B and clinical conditions of patient allowed the administration of a subsequent drug dose. However, the second panitumumab infusion was not performed because the patient refused it, fearing a second occurrence of dermatologic toxicities. Cutaneous side-effects had a complete resolution over the next several weeks.