Shinohara, A., Ikeda, M., Okuyama, H., Kobayashi, M., Funazaki, H., Mitsunaga, S., . . . Saitoh, S. (2015). Efficacy of prophylactic minocycline treatment for skin toxicities induced by erlotinib plus gemcitabine in patients with advanced pancreatic cancer: A retrospective study. American Journal of Clinical Dermatology, 16, 221–229. 

DOI Link

Study Purpose

To evaluate the effects of prophylactic minocycline on skin toxicities associated with epidermal growth factor receptor inhibitor (EGFRI) treatment

Intervention Characteristics/Basic Study Process

Over an approximate two-year period, some patients were treated with minocycline when EGFRI treatment began, and some patients were treated with minocycline when skin effects of grade 2 or 3 emerged. Data were obtained from medical records to compare these groups of patients. Minocycline was given at 200 mg per day. In both groups, heparinoid emollients were applied to skin daily and topical steroids were initiated when skin toxicity occurred. Erlotinib was administered at a dose of 100 mg daily, and 1,000 mg/m2 gemcitabine was administered intravenously over 30 minutes once every week for three weeks.

Sample Characteristics

  • N = 96
  • MEAN AGE = 66.5 years
  • AGE RANGE = 34–83 years
  • MALES: 59%, FEMALES: 41%
  • KEY DISEASE CHARACTERISTICS: All patients had advanced pancreatic cancer.

Setting

  • SITE: Single site  
  • SETTING TYPE: Outpatient  
  • LOCATION: Japan

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Study Design

  • Retrospective

Measurement Instruments/Methods

  • Common Terminology Criteria for Adverse Events (CTCAE)

Results

Significantly fewer patients who had received prophylactic minocycline developed an acneiform rash (p < 0.001). No differences existed between groups in incidence of rash of grade 2 or higher, and no difference existed between groups in the incidence of paronychia or xerosis.

Conclusions

The findings suggest that prophylactic minocycline may reduce the incidence of low-grade acneiform rash among patients receiving erlotinib and gemcitabine.

Limitations

  • Small sample (< 100)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Unintended interventions or applicable interventions not described that would influence results
  • No information regarding actual use of topical steroids was included.

Nursing Implications

The findings suggest that prophylactic minocycline might be helpful in preventing low-grade acneiform rash among patients receiving EGFRIs; however, it did not appear to have any beneficial effect in terms of the development of more severe skin effects. The study design limits the strength of this evidence. Skin toxicities associated with EGFRIs have been well documented, and little evidence exists regarding interventions that are effective to prevent and treat them. Further well designed research in this area is needed.