Pre-emptive Treatment Helped Curtail Skin Toxicity with Panitumumab
With
a pre-emptive, prophylactic skin regimen, patients who receive
panitumumab for treatment of metastatic colorectal cancer may be able
to avoid some of the skin-associated toxicities, according to data
presented at the 2009 ASCO Gastrointestinal Cancers Symposium in San
Francisco.
Edith
Mitchell, M.D., a clinical professor in the Department of Medical
Oncology at Jefferson Medical College of Thomas Jefferson University,
presented data from the study, which was the first prospective study to
compare pre-emptive and reactive skin treatment for skin toxicities
related to panitumumab. The study was co-led by Dr. Mitchell and Mario
Lacouture, M.D., an assistant professor of Dermatology at Northwestern
University’s Feinberg School of Medicine in Chicago.
Skin
toxicities are the most common adverse effects related to panitumumab,
which is a fully human monoclonal antibody that targets the epidermal
growth factor receptor (EGFR). The toxicities could include erythema,
dermatitis, pruritus, pustules, rash, and hair and nail changes.
“Panitumumab
and the other EGFR inhibitors are now key components to the treatment
strategies for metastatic colorectal cancer,” Dr. Mitchell said. “But
the majority of the patients who receive these agents suffer from skin
toxicities, and for some patients, the treatment must be interrupted or
discontinued. If we can prevent or minimize these toxicities, it would
be a significant advance in patient care.”
The
researchers studied 95 patients receiving panitumumab in combination
with irinotecan-based chemotherapy. The patients were randomized to
receive pre-emptive skin toxicity treatment initiated 24 hours prior to
the first dose of panitumumab, then given daily through week six, or
reactive skin treatment after the skin toxicity developed. The skin
treatment included moisturizers, sunscreen, topical steroids and oral
doxycycline.
The
primary endpoint was the incidence of specific grade 2 or higher skin
toxicities during the six week skin treatment period. The incidence of
these toxicities was reduced more than 50% in the group that received
pre-emptive treatment.
Quality
of life was also assessed, using the Dermatology Life Quality Index.
Patients who received the pre-emptive, prophylactic skin treatment
regimen reported an improved quality of life, even around week three,
which was the median time to first grade 2 or higher skin toxicity in
the reactive skin treatment group.
"This
study supports the notion that, as with other side effects to cancer
treatments, it is more advantageous to treat prophylactically, than to
wait for the side effect to fully develop," Dr. Lacouture said.
"Futhermore, it shows that treating early on does not affect the
benefit received from the anticancer therapy.”
Media Only Contact:
Emily Shafer
Thomas Jefferson University Hospital
Phone: (215) 955-6300
Published: 1/16/2009