Dermatological toxicity due to targeted anticancer drugs: A new challenge in Oncology practice
DOI:
https://doi.org/10.66344/jpad.v32i3.1958Abstract
Background Although newer targeted therapeutic agents have been introduced to improve the safety profile of cancer chemotherapy, yet new adverse effects, including dermatological adverse effects, have been increasingly reported after their use.
Objective We conducted this study aimed to observe the dermatological adverse effects occurring with commonly used targeted therapeutic agents at our center.
Methods This hospital based observational descriptive study conducted over a period of more than one year, included prospective adult patients put on newer targeted therapeutic agents for different types of malignancies. Patients with prior cutaneous or other drug hypersensitivity reactions and known liver and kidney diseases were excluded from the study.
Results 24 (21.43%) of 112 patients developed dermatological adverse effects, with 45 adverse effects in all. Most common cutaneous findings were xerosis/ pruritus in 7, papulopustular eruptions in 6, Hand foot syndrome and morbilliform eruptions in 3 (10.7%) each and lichenoid eruptions in 2 (7.1) patients. alopecia in 8, paronychia in 2, oral mucositis in 4 patients were the changes seen in hair, nails and mucosae respectively.
Conclusion This study re-emphasized the need to anticipate dermatological adverse effects due to new targeted chemotherapeutic agents. Proper counseling of the patients and their family members and timely management by treating physicians, oncologists and dermatologist can guide towards rationalizing the decision regarding continuation and discontinuation of such vital therapy.
References
1. Lupu I, Voiculescu N, Bacalbasa N, et al. Cutaneous complications of molecular targeted therapy used in oncology. J Med Life. 2016;9(1):19-25.
2. Shi VJ, Levy LL, Choi JN. Cutaneous manifestations of nontargeted and targeted chemotherapies. Semin Oncol. 2016; 43(3):419-25.
3. Crisci S, Amitrano F, Saggese M, et al. Overview of Current Targeted Anti-Cancer Drugs for Therapy in Onco-Hematology. Medicina (Kaunas). 2019;55(8):414.
4. Fabbrocini G, Panariello L, Caro G, et al. Acneiform Rash Induced by EGFR Inhibitors: Review of the Literature and New Insights. Skin Appendage Disord 2015;1(1):31-7.
5. Petrelli F, Borgonovo K, Barni S. The predictive role of skin rash with cetuximab and panitumumab in colorectal cancer patients: a systematic review and meta-analysis of published trials. Target Oncol. 2013;8(3):173-81.
6. Petrelli F, Borgonovo K, Cabiddu M, et al. Relationship between skin rash and outcome in non-small-cell lung cancer patients treated with anti-EGFR tyrosine kinase inhibitors: a literature-based meta-analysis of 24 trials. Lung Cancer. 2012;78(1):8-15.
7. Balagula Y, Lacouture ME, Cotliar JA. Dermatologic toxicities of targeted anticancer therapies. J Support Oncol. 2010;8(4):149-61.
8. Pavey RA, Kambil SM, Bhat RM. Dermatological adverse reactions to cancer chemotherapy. Indian J Dermatol Venereol Leprol. 2015;81:434.
9. Macdonald JB, Macdonald B, Golitz LE, et al. Cutaneous adverse effects of targeted therapies: Part I: Inhibitors of the cellular membrane. J Am Acad Dermatol. 2015;72(2):203-18.
10. Stanculeanu DL, Zob D, Toma OC, et al. Cutaneous toxicities of molecular targeted therapies. Maedica (Buchar). 2017;12(1):48–54.
11. Reyes-Habito CM, Roh EK. Cutaneous reactions to chemotherapeutic drugs and targeted therapy for cancer: Part II. Targeted therapy. J Am Acad Dermatol. 2014;71(2):217.
12. Amitay-Laish I, Stemmer SM, Lacouture ME. Adverse cutaneous reactions secondary to tyrosine kinase inhibitors including imatinib mesylate, nilotinib, and dasatinib. Dermatol Ther. 2011;24(4):386-95.
13. Valeyrie L, Bastuji-Garin S, Revuz J, et al. Adverse cutaneous reactions to imatinib (STI571) in Philadelphia chromosome-positive leukemias: a prospective study of 54 patients. J Am Acad Dermatol. 2003;48(2):201-6.
14. Lee WJ, Lee JL, Chang SE, et al. Cutaneous adverse effects in patients treated with the multitargeted kinase inhibitors sorafenib and sunitinib. Br J Dermatol. 2009;161(5):1045-51.
15. Lipworth AD, Robert C, Zhu AX. Hand-foot syndrome (hand-foot skin reaction, palmar-plantar erythrodysesthesia): focus on sorafenib and sunitinib. Oncology. 2009;77(5):257-71.
16. Belum VR, Marulanda K, Ensslin C, et al. Alopecia in patients treated with molecularly targeted anticancer therapies. Ann Oncol. 2015;26(12):2496-502.
17. Vigarios E, Epstein JB, Sibaud V. Oral mucosal changes induced by anticancer targeted therapies and immune checkpoint inhibitors. Support Care Cancer. 2017; 25(5):1713-39.
18. Pinto C, Barone CA, Girolomoni G, et al. Management of Skin Reactions During Cetuximab Treatment in Association With Chemotherapy or Radiotherapy: Update of the Italian Expert Recommendations. Am J Clin Oncol. 2016;39(4):407-15.
19. Cho YT, Chen KL, Chu CY. Treatment strategies of epidermal growth factor receptor inhibitor-induced skin toxicities: pre-emptive or reactive? Ann Transl Med. 2016;4(16):318.
20. Pastore S, Mascia F, Mariani V, et al. The epidermal growth factor receptor system in skin repair and inflammation. J Invest Dermatol. 2008;128:1365-74.
21. Owczarek W, Słowińska M, Lesiak A, et al. The incidence and management of cutaneous adverse events of the epidermal growth factor receptor inhibitors. Postepy Dermatol Alergol. 2017;34(5):418-28.
22. Osio A, Mateus C, Soria JC, et al. Cutaneous side-effects in patients on long-term treatment with epidermal growth factor receptor inhibitors. Br J Dermatol. 2009;161(3):515-21.
23. Zimmerman EI, Gibson AA, Hu S, et al. Multikinase Inhibitors Induce Cutaneous Toxicity through OAT6-Mediated Uptake and MAP3K7-Driven Cell Death. Cancer Res. 2016;76(1):117-26.
24. Kozuki T. Skin problems and EGFR-tyrosine kinase inhibitor. Jpn J Clin Oncol. 2016; 46(4):291-8.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Mohammad Hussain Mir, Parvaiz Rather, Farhana Siraj Bagdadi

This work is licensed under a Creative Commons Attribution 4.0 International License.
Submission declaration
Authors retain the copyright to their work and grant the 'Journal of Pakistan Association of Dermatologists (JPAD)' the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal.
By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.






