Ocvirk, J., & Cencelj, S. (2009). Management of cutaneous side-effects of cetuximab therapy in patients with metastatic colorectal cancer. Journal of the European Academy of Dermatology and Venereology, 24, 453–459.

To evaluate the effectiveness of various interventions to manage the skin effects of cetuximab.

All 31 patients developed the typical acneform rash that occurs from six to 20 days after the first dose of cetuximab. Emollients were recommended for grade 1 acneform eruptions. For patients who developed grade 2 reactions, the same topical treatment as for grade 1 was used, with the addition of topical antibiotic treatment: 1% solution of clindamycin BID for two to three weeks until pustules ceased. The H1 antihistamine loratadine was recommended to relieve itching.

All patients were advised to wash with bath oil or shower with tepid water, avoid sun exposure, and use sunscreen products with high sun protection factor. For grade 1 rash, patients were advised to use topical preparations for moisturizing that contain dexpanthenol (e.g., Bepanthen^® cream or lotion), applied BID. For grade 2 rash, patients used the same topical preparation, plus a topical antibiotic treatment. Finally, for grade 3 rash, treatment with cetuximab was discontinued until the reaction resolved and a combination of emollients, topical antibiotics, and systemic antibiotics was given.

• The study reported on a sample of 31 patients with metastatic colorectal cancer who were treated with cetuximab as third-line or further-line treatment after failure with irinotecan.
• Mean patient age was 56.3 years (range 36–76 years).
• Nineteen patients were men, and 12 were women.

Institute of Oncology in Ljubljana, Slovenia

This was a descriptive study on the effectiveness of various interventions for dermatological toxicities related to cetuximab.

Skin toxicity was evaluated using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 3.

• Of 31 patients in this study, 6 had grade 3 rashes, 16 had grade 2 rashes, and 9 had grade 1 acne-like rashes.
• The authors reported the numbers of patients who used various treatments, but did not report the effectiveness of emollients for grade 1 or grade 2 rashes. They stated, “Generally, for treatment of skin reactions (relief of pain, discomfort, and healing) for the patients experiencing Grade 1 acneform eruptions, the skin should be treated with emollients and moisturizers (containing dexpanthenol) to ensure a maximal hydration of the skin for at least two weeks.”

Grade 3 skin rash was generally manageable with emollients, topical antibiotics, and systemic antibiotics. The effectiveness of emollients on grade 1 and 2 rashes was not reported.

• This was a descriptive study, not a randomized controlled trial.
• The sample of patient reports was small.
• Treatment was based on expert opinion.
• A combination of interventions was used; therefore, determining the effectiveness of the individual interventions is difficult.