Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2019; 25(29): 4007-4018
Published online Aug 7, 2019. doi: 10.3748/wjg.v25.i29.4007
Management of skin toxicities during panitumumab treatment in metastatic colorectal cancer
Olivier Bouché, Meher Ben Abdelghani, Jean-Luc Labourey, Simon Triby, René-Jean Bensadoun, Thomas Jouary, Gaétan Des Guetz
Olivier Bouché, Department of Gastroenterology and Digestive Oncology, Hôpital Robert Debré, CHU Reims, Reims 51000, France
Meher Ben Abdelghani, Oncology Department, Centre Paul Strauss, Strasbourg 67000, France
Jean-Luc Labourey, Oncology Department, Centre Hospitalier, Carcassonne 11000, France
Simon Triby, Medical Department, AMGEN France, Boulogne-Billancourt 92100, France
René-Jean Bensadoun, Radiation Oncology, Centre de Haute Energie, Nice 06000, France
Thomas Jouary, Dermatology Department, Hôpital Saint-André, CHU de Bordeaux, Bordeaux 33000, France
Gaétan Des Guetz, Oncology Department, Avicenne Hospital, Bobigny 93000, France
Author contributions: Bouché O, Ben Abdelghani M, Labourey JL, Bensadoun RJ, Jouary T, and Des Guetz G participated to the design of the study; Bouché O, Ben Abdelghani M, Labourey JL, Bensadoun RJ, Jouary T, Des Guetz G, and Triby S participated to the collection and interpretation of data, and revised the manuscript.
Supported by Amgen 20090656 POPEC.
Institutional review board statement: Study protocol, information sheet and all other relevant documents received the approval of CCTIRS (French consultative committee for the processing of information in the field of health research).
Informed consent statement: The study was non-interventional and patients were informed both orally and in writing on the objectives of the study. The study was conducted according to the current revision of the 1964 Helsinki declaration and with the French laws and regulations.
Conflict-of-interest statement: Bouché O: Amgen, Roche, Merck Sereno, Bayer, Pierre Fabre, Servier; Ben Abdelghani M: Amgen, Sanofi, Bayer, Roche, Servier; Triby S: Amgen employee; Labourey JL, Bensadoun RJ, Jouary T, and Des Guetz G: no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the “STROBE Statement—checklist of items” and the manuscript was prepared and revised according to the “STROBE Statement-checklist of items”.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Olivier Bouché, MD, Professor, Department of Gastroenterology and Digestive Oncology, Hôpital Robert Debré, CHU Reims, Avenue du Général Koenig, Reims 51092, France. obouche@chu-reims.fr
Telephone: +33-326-783113 Fax: +33-326-788836
Received: January 17, 2019
Peer-review started: January 18, 2019
First decision: January 30, 2019
Revised: February 7, 2019
Accepted: February 22, 2019
Article in press: February 23, 2019
Published online: August 7, 2019
Abstract
BACKGROUND

Anti-epidermal growth factor receptor therapy is associated with skin adverse events not previously reported with conventional chemotherapy. Prophylactic actions are recommended, but routine clinical management of these toxicities and their impact on quality of life remain unknown.

AIM

To assess the dermatological toxicities reported after panitumumab initiation, their impact on the quality of life and the clinical practices for their management.

METHODS

Patients included in this prospective multicenter observational study were over 18 years of age and began treatment with panitumumab for wild-type KRAS metastatic colorectal cancer. The incidence of dermatological toxicities, clinical practices for their management and impact on quality of life were recorded during a 6-mo follow-up.

RESULTS

Overall, 229 patients (males, 57.6%; mean age, 66.2 years) were included. At day 15, 59.3% of patients had dermatological toxicity; the rate peaked at month 2 (74.7%) and decreased at month 6 (46.5%). The most frequent dermatological toxicities were rash/acneiform rash, xerosis and skin cracks. At least one preventive treatment was administered to 65.9% of patients (oral antibiotics, 84.1%; emollients, 75.5%; both, 62.9%). The rates of patients who received at least one curative treatment peaked at month 2 (63.4%) and decreased at month 6 (44.8%). The impact of the dermatological toxicities on quality of life was limited as assessed with Dermatology Life Quality Index scores and inconvenience visual analogic scale score. The rates of topical corticosteroids administration and visits to specialists were low.

CONCLUSION

The rates of the different skin toxicities peaked at various times and were improved at the end of follow-up. Nevertheless, their clinical management could be optimized with a better adherence to current recommendations. The impact of skin toxicities on patient’s quality of life appeared to be limited.

Keywords: Metastatic colorectal cancer, Epidermal growth factor receptor inhibitors, Panitumumab, Skin toxicity, Quality of life

Core tip: Anti-epidermal growth factor receptor therapy is associated with skin adverse events not previously reported with conventional chemotherapy. Prophylactic actions are recommended, but routine clinical management of these toxicities and their impact on quality of life remain unknown. This observational study describes a cohort of patients who began treatment with panitumumab for metastatic colorectal cancer. The rates of the different skin toxicities peaked at various times and were improved at the end of the follow-up. Nevertheless, their clinical management could be optimized with a better adherence to current recommendations. The impact of skin toxicities on patient’s quality of life appeared to be limited.