This study found that oral tetracycline did not significantly lessen rash incidence or severity in patients taking EGFR inhibitors. Scope et al. conducted a randomized double-blind controlled trial of oral minocycline for cetuximab #BEZ235 nmr randurls[1|1|,|CHEM1|]# induced acneiform eruption published in 2007 (11). Of 48 patients enrolled, half were randomly assigned to minocycline and the other half to placebo for 8 weeks of treatment. Total facial lesion counts were significantly lower for Inhibitors,research,lifescience,medical patients receiving treatment rather than placebo at week one through four. At week four patients in the minocycline treatment group
had a lower frequency of moderate to severe rash than patients receiving placebo and at week eight there were diminished total facial lesion counts. No patients treated with minocycline had to discontinue cetuximab treatment due to acneiform eruption but four patients in the placebo group had to interrupt Inhibitors,research,lifescience,medical treatment because of grade 3 skin rash. Topical tazarotene
use was also studied. Tazarotene was not helpful in controlling the acneiform rash and caused significant irritation, supporting the observation that this condition does not respond like traditional acne vulgaris. De Noronha et al. reviewed the management of cutaneous side effects during erlotinib and cetuximab treatment in lung and colorectal cancer patients (12). They presented a treatment Inhibitors,research,lifescience,medical algorithm to help manage these patients. Upon initiation of treatment with the EGFR inhibitor they started patients Inhibitors,research,lifescience,medical on daily sunscreen, mild skin cleanser, and moisturizing cream. In patients who developed mild acneiform eruptions they began topical antibiotics plus topical benzoyl peroxide. For patients who developed grade 2 or 3 cutaneous reactions they started oral doxycycline or minocycline at a dose of 100 mg/day. In one case that was not responsive to oral antibiotics
they initiated oral low dose isotretinoin. Antihistamines Inhibitors,research,lifescience,medical were recommended when patients experienced pruritis. In the nineteen cases described by these authors none had to stop EGFR inhibitor treatment because of cutaneous Thymidine kinase side effects, all but one patient showed improvement on oral antibiotics, and 42% experienced a complete response. The skin toxicity evaluation protocol with panitumumab (STEPP) study conducted by Lacouture et al. was a randomized trial evaluating pre-emptive versus reactive treatment with doxycycline for patients receiving panitumumab (13). All patients started a standard regimen of daily skin moisturizer, sunscreen, and topical steroid at the onset of chemotherapy. Forty-eight patients also received pre-emptive treatment with doxycycline 100 mg twice per day, while forty-seven received doxycycline only after skin toxicity developed. The incidence of grade 2 skin toxicities during the six-week treatment period was 29% for the pre-emptive treatment group and 62% for the reactive treatment group.