Tejwani A, Wu S, Jia Y, Agulnik M, Millender L, Lacouture ME, et al.
Cancer. Date of publication 2009 Mar 15;volume 115(6):1286-99.
1. Cancer. 2009 Mar 15;115(6):1286-99. doi: 10.1002/cncr.24120.
Increased risk of high-grade dermatologic toxicities with radiation plus
epidermal growth factor receptor inhibitor therapy.
Tejwani A(1), Wu S, Jia Y, Agulnik M, Millender L, Lacouture ME.
Author information:
(1)Tulane University School of Medicine, New Orleans, Louisiana, USA.
BACKGROUND: The addition of epidermal growth factor receptor (EGFR) inhibitors to
radiotherapy has produced increased locoregional control and has reduced
mortality from various solid tumors with few additional toxicities. Although
anecdotal reports have suggested increased radiation dermatitis, the overall
effect of these regimens on dermatologic toxicities has not been ascertained.
METHODS: Dermatologic toxicity data were analyzed from abstracts presented at the
annual meetings of the American Society of Clinical Oncology, the American
Society of Therapeutic Radiology and Oncology, Cochrane Collaboration, MEDLINE,
and EMBASE databases. Phase 1, 2, and 3 trials that reported on radiation
dermatitis, rash, and mucositis were included. Collaborative group, phase 3,
randomized radiotherapy and chemoradiation trials served as controls. The summary
incidence rate and relative risk were calculated using a random-effects or
fixed-effects model, depending on the heterogeneity of included studies.
RESULTS: The summary incidence of high-grade radiation dermatitis in patients who
received radiation plus EGFR inhibitors was 31.3% (95% confidence interval [95%
CI], 17.7%-49.1%), rash in 16.1% (95% CI, 12.8%-20.1%), and mucositis occurred in
52.7% (95% CI, 38.1%-66.9%). When the combination of radiotherapy plus EGFR
inhibitors was compared with radiation alone, the risk ratio for radiation
dermatitis was 2.38 (95% CI, 1.8-3.2; P<.001), rash was 3.01 (95% CI, 2.0-4.6;
P<.001), for mucositis it was 1.76 (95% CI, 1.5-2.0; P<.001), suggesting that
there was an increased risk of dermatologic toxicities with the combined regimen.
CONCLUSIONS: EGFR inhibitors combined with radiation were associated with a
significant increase in the risk for high-grade radiation dermatitis, rash, and
mucositis. Although increased rash is expected with EGFR inhibitors, in-field
dermatitis and mucositis represent new safety concerns. Improved reporting and
management strategies are critical for quality of life and the optimization of
radiation plus EGFR inhibitor protocols.
Copyright (c) 2009 American Cancer Society.
DOI: 10.1002/cncr.24120
PMID: 19170238 [Indexed for MEDLINE]
