More Nail Inflammation With Second Generation Cancer Treatment with EGFR TKIs

Chia-Yu Chu, MD, PhD Associate Professor, Department of Dermatology National Taiwan University Hospital

Dr. Chia-Yu Chu

MedicalResearch.com Interview with:
Chia-Yu Chu, MD, PhD

Associate Professor, Department of Dermatology
National Taiwan University Hospital

Medical Research: What is the background for this study? What are the main findings?

Dr. Chia-Yu Chu: It has been well known that EGFR TKIs could cause skin toxicities (acneiform eruptions, pruritus, xerosis and paronychia). However, incidences of these skin toxicities have varied according to the different clinical trials, some of which even simply use “skin rash” instead of specific cutaneous findings in the reports.

Afatinib, in contrast to first generation EGFR TKIs like gefitinib and erlotinib, is a second generation EGFR TKI with irreversible inhibition to not only EGFR, but also HER2 and ErbB4. Whether afatinib cause more skin toxicities remained unknown.

Many of our patients received 2 or even 3 different EGFR TKIs with adequate drug exposure and washout period. Therefore, we had an opportunity to compare skin toxicities in “same patients” receiving different EGFR TKIs, and we found that around 30% of patients receiving afatinib developed paronychia whereas only 10% in gefetinib or erlotinib. This was the only significant difference between the 3 drugs. We also found afatinib treated patients needed significantly more dermatologic visits within 180 days of treatments and the reason was due to higher incidence of afatinib-related paronychia. Interestingly, regardless of causative agents, once skin toxicities developed they could be managed effectively in the same manners.

Medical Research: What should clinicians and patients take away from your report?

Dr. Chia-Yu Chu: Aggressive and early dermatologic care for patients receiving EGFR TKIs should be mandatory. Specialized dermatologists should join the integrated oncology treatment team for better patient care.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Chia-Yu Chu: Our findings should be confirmed by further prospective studies. When designing clinical trials, dermatologists should be enrolled and the skin toxicities should be specified.

Citation:

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Chia-Yu Chu, MD, PhD (2015). More Nail Inflammation With Second Generation Cancer Treatment with EGFR TKIs