Management of dermatologic toxicities associated with monoclonal antibody epidermal growth factor receptor inhibitors: A case review
A 74-year-old man was undergoing treatment with fluoropyrimidine and irinotecan-based chemotherapy regimen (continuous infusion every 14 days) and cetuximab (Erbitux® - Merck KGaA) (once a week) for EGFR-expressing rectal carcinoma with KRAS wild-type. The patient had no history of severe hypersensitivity reactions to anti-EGFR agent.\nOn the morning of October 29th, 2012, he was admitted to the oncology outpatient service to receive his first infusion of cetuximab (720 mg, 400 mg/m2 body surface area). Prior to infusion, the patient was administered with premedication drugs: ondansetron (8 mg intravenously) and atropine sulfate (0.25 mg subcutaneously). Four days after beginning the therapy, he developed a moderately intense erythema with papules on the face. After clinical evaluation, the skin reaction was not attributed to DDIs. A diagnosis of a cetuximab-related Grade 2B papulopustular skin rash (NCI-CTCAE v4.0) was made while a decision to continue initial treatment protocol, without dose modifications, was taken, according to manufacturer's guidelines for management of drug-related skin toxicities. The patient was advised both systemic and topical treatment: oral levofloxacin (500 mg once daily for 5 days); moisturizing, non-perfumed and soothing cream (twice daily application for 1 week); fusidic acid and betamethasone cream – 2% + 0.1% (twice daily application for 1 week). He was also advised to take sun-protective measures and avoid activities and products that were likely to dry skin, in order to reduce the risk of rash exacerbation.\nThese pre-emptive and treatment strategies improved skin symptoms and patient's compliance with therapy.