EGFR inhibitors
|
-Monoclonal antibodies: cetuximab and panitumumab
-TKI specific for EGFR: erlotinib and gefitinib
-Less specific multikinase inhibitors: vandetanib |
Papulopustular eruption (starts on the first 2 weeks) |
Prevention:
|
|
-Systemic antibiotics for the first 6-8 weeks (tetracyclines), sunscreen |
IB |
Treatment:
|
|
-Low potency topical steroids |
III |
-Systemic antibiotics (tetracyclines) |
IB |
-Systemic isotretinoin (low doses) |
III |
-Culture-driven antibiotics if secondary infection |
IB |
Xerosis |
-Limited shower time, use of gentle cleansers (pH-neutral soaps or syndets), regular use of emollients |
III |
-Topical steroid if eczematous lesions |
III |
Paronychia and pyogenic granuloma like lesions |
Prevention:
|
|
-Systemic antibiotics (tetracyclines) |
IB |
-Antiseptic solutions |
III |
Treatment:
|
|
-Topical steroids |
III |
-Systemic antibiotics (tetracyclines) |
III |
-Culture-driven antibiotics if secondary infection |
IB |
Fissures |
Protective coverings (hydrocolloid, biological or cyanoacrylate glue), barrier creams (petroleum jelly, zinc oxide cream) and thick emollients |
IIB |
Hair changes |
-Nonscarring alopecia: topical minoxidil |
IB |
-Inflammatory and scarring alopecia: topical steroids |
III |
-Trichomegaly: eyelash trimming |
III |
-Hypertrichosis: laser hair reduction |
IB |
KIT and BCR-ABL inhibitors
|
Imatinib, nilotinib, dasatinib |
Exanthema (rash) |
Topical steroids or short courses of oral steroids |
III |
Hypopigmentation |
Reversible after treatment interruption |
III |
Antiangiogenic agents
|
-Selective VEGFR inhibitors: bevacizumab and ranibizumab Non-selective multikinase inhibitors: sorafenib, pazopanib, sunitinib |
Hand-foot skin reaction |
Prevention:
|
|
-Use thick cotton gloves and/or socks; urea based emollients; avoid irritants and tight clothing and shoes; avoid extremes of temperature, pressure and friction |
III |
-Pretreatment evaluation with a podiatrist with callosity chopping and the use of orthopedic shoe inserts when needed |
III |
-Urea based emollients |
IB |
Treatment:
|
|
-Keratolytic agents |
III |
-Topical corticosteroids |
III |
-Potent topical steroid |
III |
-For relief of symptoms, cool compresses or emergence of hands and feet on cool water, topical anesthetics and NSAIDs |
III |
-Hydrocolloid dressings? |
IB |
Pigmentary changes |
-Hypopigmentation of hair and skin (pazopanib and sunitinib), yellow discoloration of skin (sunitinib) - reversible after discontinuation |
III |
Hair and scalp |
-Seborrheic dermatitis-like rash: topical steroids |
III |
-Non-scarring alopecia: topical minoxidil |
IV |
RAF inhibitors
|
Vemurafenib and dabrafenib |
Exanthema (rash) |
-Oral antihistamines, topical or short courses of systemic steroids |
III |
Temporary treatment interruption might be necessary |
|
Photosensitivity |
Prevention: photoprotective measures |
IIB |
Treatment: topical or short courses of systemic steroids |
III |
Mostly vemurafenib, UVA-induced |
Keratosis pilaris like eruption |
Keratolytics and emollients, gentle skin care |
III |
Seborrheic dermatitis-like |
Topical steroids |
III |
Hand-foot skin reaction |
See above (antiangiogenic agents) |
|
Keratoacanthomas and squamous cell carcinomas |
-Frequent dermatological monitoring |
III |
-If few lesions: surgical excision |
III |
-If multiple lesions: 5-FU, systemic retinoids or photodynamic therapy |
IIA/B |
Association with a MEKi decreases lesions |
Warts and verrucal keratoses |
-Destructive or surgical measures |
III |
-Topical treatments: keratolytics, 5-FU, imiquimod |
III |
MEK inhibitors
|
Cobimetinibe, trametinibe, selumetinibe |
Papulopustular eruption |
See EGFR inhibitors above |
|
Xerosis |
|
Paronychia |
|
Exanthema (rash) |
-Oral antihistamines, topical or short courses of systemic steroids |
III |
mTOR inhibitors |
Rapamycin, everolimus, sirolimus |
Stomatitis |
Antiseptic washes, topical steroids and anesthetics |
IV |