PMID- 34779921
OWN - NLM
STAT- MEDLINE
DCOM- 20220131
LR  - 20220131
IS  - 1433-7339 (Electronic)
IS  - 0941-4355 (Linking)
VI  - 30
IP  - 3
DP  - 2022 Mar
TI  - A multicenter study of skin toxicity management in patients with left-sided, 
      RAS/BRAF wild-type metastatic colorectal cancer treated with first-line 
      anti-EGFR-based doublet regimen: is there room for improvement?
PG  - 2455-2465
LID - 10.1007/s00520-021-06652-5 [doi]
AB  - BACKGROUND: Skin toxicity in patients affected by metastatic colorectal cancer 
      (mCRC) treated with epidermal growth factor receptor (EGFR) inhibitors is well 
      known. However, ad hoc ESMO guidelines have only recently been published. AIM AND 
      METHODS: To describe the management (pre-emptive or reactive) of 
      anti-EGFR-related cutaneous adverse events (AEs), in a real-life clinical 
      context, in a selected population of patients with left-sided, metastatic 
      RAS/BRAF wild-type mCRC treated with doublet chemotherapy plus anti-EGFR 
      monoclonal antibody (i.e., panitumumab or cetuximab) as first-line regimen at 22 
      Institutions. The measured clinical outcomes were treatment-related adverse 
      events, objective response rate (ORR), progression-free survival (PFS), and 
      overall survival (OS). RESULTS: Of 515 patients included in the analysis, 173 
      (33.6%) received a pre-emptive and 342 (66.4%) a reactive treatment. The median 
      follow-up period for the overall population was 30.0 months. A significantly 
      lower incidence of any grade acneiform rash was found in the pre-emptive compared 
      to the reactive cohort both in the overall population (78.6% vs 94.4%, p < 0.001) 
      and in patients treated with panitumumab (76.1% vs 93.7%, p < 0.001) or cetuximab 
      (83.3% vs 95.4%, p = 0.004), respectively. A lower incidence of any grade (41.6% 
      vs 50.9%, p = 0.047) but a higher incidence of G3-G4 (9.2% vs 4.7%, p = 0.042) 
      paronychia/nail disorders were found in the pre-emptive compared to the reactive 
      cohort. Nevertheless, a lower rate of patients within the reactive compared to 
      the pre-emptive cohort was referred to dermatological counseling (21.4% vs 15.3%, 
      respectively, p = 0.001). A higher rate of anti-EGFR therapy modification was 
      needed in the pre-emptive compared to the reactive cohort (35.9% vs 41.6%, 
      respectively, p < 0.001). The pre-emptive approach did not reduce the efficacy of 
      antineoplastic therapy compared to the reactive in terms of ORR (69.2% vs 72.8%), 
      median PFS (12.3 vs 13.0 months), and median OS (28.8 vs 33.5 months). 
      CONCLUSION: Although recommended by international guidelines, the pre-emptive 
      approach of anti-EGFR-related skin toxicity in mCRC patients still appears less 
      adopted in daily clinical practice, compared to the reactive one. A wider 
      reception and application of this indication is desirable to improve patients' 
      quality of life without compromising the continuity and efficacy of 
      antineoplastic therapy.
CI  - (c) 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
      part of Springer Nature.
FAU - Antonetti, Paolo
AU  - Antonetti P
AD  - Dermatology, St. Salvatore Hospital, L'Aquila, Italy.
AD  - Department of Biotechnological and Applied Clinical Sciences, University of 
      L'Aquila, Via Vetoio, Coppito 2, 67100, L'Aquila, Italy.
FAU - Fargnoli, Maria Concetta
AU  - Fargnoli MC
AUID- ORCID: 0000-0003-4629-7762
AD  - Dermatology, St. Salvatore Hospital, L'Aquila, Italy. fargnoli@univaq.it.
AD  - Department of Biotechnological and Applied Clinical Sciences, University of 
      L'Aquila, Via Vetoio, Coppito 2, 67100, L'Aquila, Italy. fargnoli@univaq.it.
FAU - Porzio, Giampiero
AU  - Porzio G
AD  - Department of Biotechnological and Applied Clinical Sciences, University of 
      L'Aquila, Via Vetoio, Coppito 2, 67100, L'Aquila, Italy.
AD  - Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy.
FAU - Salvatore, Lisa
AU  - Salvatore L
AD  - Universita Cattolica del Sacro Cuore, Rome, Italy.
AD  - Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico 
      Universitario Agostino Gemelli, IRCCS, Rome, Italy.
FAU - Filippi, Roberto
AU  - Filippi R
AD  - Department of Oncology, University of Turin, Torino, Italy.
AD  - Division of Medical Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, 
      TO, Italy.
AD  - Centro Oncologico Ematologico Subalpino, Azienda Universitaria Ospedaliera Citta 
      della Salute e della Scienza di Torino, Torino, Italy.
FAU - Ghidini, Michele
AU  - Ghidini M
AD  - Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 
      Milano, Italy.
FAU - Nigro, Olga
AU  - Nigro O
AD  - Medical Oncology, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, 
      Varese, Italy.
FAU - Gelsomino, Fabio
AU  - Gelsomino F
AD  - Department of Oncology and Hematology, Division of Oncology, University Hospital 
      of Modena, Modena, Italy.
FAU - Zurlo, Ina Valeria
AU  - Zurlo IV
AD  - Medical Oncology, "Vito Fazzi" Hospital, Lecce, Italy.
FAU - Dell'Aquila, Emanuela
AU  - Dell'Aquila E
AD  - Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
FAU - Lombardi, Pasquale
AU  - Lombardi P
AD  - Department of Medical Oncology, Hospital Clinico Universitario de Valencia, 
      INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain.
FAU - Keranen, Susana Rosello
AU  - Keranen SR
AD  - CIBERONC, Instituto de Salud Carlos III, Madrid, Spain.
FAU - Depetris, Ilaria
AU  - Depetris I
AD  - Medical Oncology, ASL TO4, Ospedale Civile di Ivrea, Ivrea, Turin, Italy.
FAU - Giampieri, Riccardo
AU  - Giampieri R
AD  - Clinica Oncologica e Centro Regionale di Genetica Oncologica, Universita 
      Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy.
FAU - Morelli, Cristina
AU  - Morelli C
AD  - Medical Oncology Unit and PhD program in Systems and Experimental Medicine (XXXV 
      cycle), Tor Vergata University Hospital, Viale Oxford, 81, 00133, Rome, Italy.
FAU - De Tursi, Michele
AU  - De Tursi M
AD  - Department of Medical, Oral and Biotechnological Sciences and Center for Advance 
      Studies and Technology (CAST), G. D'Annunzio University, Chieti, Italy.
AD  - Clinical Oncology Unit, S.S. Annunziata Hospital, Chieti, Italy.
FAU - Di Pietro, Francesca Romana
AU  - Di Pietro FR
AD  - IRCCS Istituto Dermopatico dell'Immacolata (IDI), Rome, Italy.
FAU - Zanaletti, Nicoletta
AU  - Zanaletti N
AD  - Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale 
      Tumori-IRCCS-Fondazione G.Pascale, Napoli, Italy.
FAU - Vitale, Pasquale
AU  - Vitale P
AD  - Department of Precision Medicine, Universita della Campania "Luigi Vanvitelli", 
      80131, Napoli, Italy.
AD  - Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy.
FAU - Garajova, Ingrid
AU  - Garajova I
AD  - Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43126, 
      Parma, Italy.
FAU - Spinelli, Gian Paolo
AU  - Spinelli GP
AD  - UOC Territorial Oncology - AUSL Latina-CdS Aprilia - University of Rome 
      "Sapienza", Latina, Italy.
FAU - Zoratto, Federica
AU  - Zoratto F
AD  - Medical Oncology, Santa Maria Goretti Hospital, Latina, Italy.
FAU - Roberto, Michela
AU  - Roberto M
AD  - Department of Clinical and Molecular Medicine, Sapienza University of Rome, 
      Oncology Unit, Sant'Andrea Hospital, Rome, Italy.
FAU - Petrillo, Angelica
AU  - Petrillo A
AD  - Medical Oncology Unit, Ospedale del Mare, Naples, Italy.
FAU - Aimar, Giacomo
AU  - Aimar G
AD  - Universita Cattolica del Sacro Cuore, Rome, Italy.
AD  - Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico 
      Universitario Agostino Gemelli, IRCCS, Rome, Italy.
FAU - Cortellini, Alessio
AU  - Cortellini A
AD  - Department of Biotechnological and Applied Clinical Sciences, University of 
      L'Aquila, Via Vetoio, Coppito 2, 67100, L'Aquila, Italy.
AD  - Department of Surgery and Cancer, Imperial College London, London, UK.
FAU - Pensieri, Maria Vittoria
AU  - Pensieri MV
AD  - Department of Biotechnological and Applied Clinical Sciences, University of 
      L'Aquila, Via Vetoio, Coppito 2, 67100, L'Aquila, Italy.
AD  - Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy.
FAU - Ficorella, Corrado
AU  - Ficorella C
AD  - Department of Biotechnological and Applied Clinical Sciences, University of 
      L'Aquila, Via Vetoio, Coppito 2, 67100, L'Aquila, Italy.
AD  - Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy.
FAU - Ferri, Claudio
AU  - Ferri C
AD  - Department of Life, Health and Environmental Sciences, University of L'Aquila, 
      L'Aquila, Italy.
FAU - Parisi, Alessandro
AU  - Parisi A
AD  - Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy.
AD  - Department of Life, Health and Environmental Sciences, University of L'Aquila, 
      L'Aquila, Italy.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20211115
PL  - Germany
TA  - Support Care Cancer
JT  - Supportive care in cancer : official journal of the Multinational Association of 
      Supportive Care in Cancer
JID - 9302957
RN  - 6A901E312A (Panitumumab)
RN  - EC 2.7.11.1 (BRAF protein, human)
RN  - EC 2.7.11.1 (Proto-Oncogene Proteins B-raf)
RN  - PQX0D8J21J (Cetuximab)
SB  - IM
MH  - Antineoplastic Combined Chemotherapy Protocols/adverse effects
MH  - Cetuximab/adverse effects
MH  - *Colorectal Neoplasms/drug therapy/genetics
MH  - Humans
MH  - Panitumumab/therapeutic use
MH  - *Proto-Oncogene Proteins B-raf/genetics/therapeutic use
MH  - Quality of Life
OTO - NOTNLM
OT  - Acneiform rash
OT  - Anti-EGFR
OT  - Cetuximab
OT  - Panitumumab
OT  - Paronychia
OT  - Pre-emptive
OT  - Reactive
OT  - mCRC
EDAT- 2021/11/16 06:00
MHDA- 2022/02/01 06:00
CRDT- 2021/11/15 12:27
PHST- 2021/08/03 00:00 [received]
PHST- 2021/10/21 00:00 [accepted]
PHST- 2021/11/16 06:00 [pubmed]
PHST- 2022/02/01 06:00 [medline]
PHST- 2021/11/15 12:27 [entrez]
AID - 10.1007/s00520-021-06652-5 [pii]
AID - 10.1007/s00520-021-06652-5 [doi]
PST - ppublish
SO  - Support Care Cancer. 2022 Mar;30(3):2455-2465. doi: 10.1007/s00520-021-06652-5. 
      Epub 2021 Nov 15.