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Managing skin toxicities related to panitumumab

Hagit Bergman, Tara Walton, Ryan Del Bel, Jack T. Seki, Ava Rafii, Wei Xu, Gideon Koren, Neil Shear, Monika K. Krzyzanowska, Doris Howell, Geoffrey Liu

Journal of the American Academy of Dermatology, Volume 71, Issue 4, October 2014, Pages 754-759

Editors’ comment: Dr Ricardo Caponero

Dermatologic toxicities related to panitumumab are common; however, the way they are reported and managed varies among physicians. To prevent progression, toxicities must be assessed and treated early and aggressively, according to severity grading. Dermatologists could aid oncologists in choosing the best management strategies.

Background
Dermatologic toxicities from targeted agents such as panitumumab can interfere with cancer treatment.

Objective
We sought to evaluate the rash assessment and management in a consecutive patient cohort who received panitumumab for colorectal cancer treatment.

Methods
This was a retrospective chart review.

Results
Skin toxicity, consisting of papulopustular rash, was experienced by 32 of 34 patients. The majority (85%) developed the rash by the end of the second infusion cycle. Patients presented with a mild (41%), moderate (38%), and severe (21%) rash, and progressed to an extensive rash without appropriate treatment. A grading system was used for 65% of patients to document severity.

Limitations
Small sample size limited power in analysis. Rash severity had to be inferred based on rash description and management in 11 of the patients.

Conclusion
Dermatologic toxicities related to panitumumab are common; however, the way they are reported and managed varies among physicians. To prevent progression, toxicities must be assessed and treated early and aggressively, according to severity grading. Dermatologists could aid oncologists in choosing the best management strategies.

Keywords: Common Toxicity Criteria for Adverse Events; epidermal growth factor receptor inhibitors; panitumumab; papulopustular rash; skin toxicity

Abbreviations used: CTCAE (Common Toxicity Criteria for Adverse Events); EGFR (epidermal growth factor receptor); PMCC (Princess Margaret Cancer Center)

Supported by Cancer Care Ontario and Ontario Patient-Reported Outcomes of Symptoms and Toxicity. Dr Liu is supported by the Alan B. Brown Chair in Molecular Genomics and the Posluns Family Fund. Dr Howell is supported by the Royal Bank of Canada (RBC) Chair in Oncology Nursing Research

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