Complex Approach to the Management of Acneiform Rash Induced by Epidermal Growth Factor Receptor Inhibitors

Abstract

Rationale. Acneiform (papulopustular) rash is the leading dermatological adverse event of EGFR inhibitors. The development of optimal regimens for the supportive treatment of acneiform rash remains an important interdisciplinary problem in supportive oncology. Aims — to comparatively evaluate the clinical efficacy of the supportive treatment for acneiform rash induced by epidermal growth factor receptor inhibitors, including topical treatment with ivermectin cream and balneotherapy. Methods. In an open, prospective, randomized study, data from 114 patients with acneiform rash induced by monoclonal antibodies to EGFR were analyzed. All groups received intermittent supportive treatment according to a single regimen, continuous external therapy included: in group 1 — hypotonic thermal water, in group 2 — ivermectin 1% cream, in group 3 — hypotonic thermal water and ivermectin 1% cream. The observation period was 3 months. Acneiform rash severity was assessed using the CTCAE-NCI v5.0 criteria and a developed acneiform rash clinical severity scale. The intensity of subjective symptoms was assessed using a 10-point visual analog scale (VAS). The modified dermatological life quality index (mDLQI) was used to assess the impact of acneiform rash on patient’s quality of life. Results. A significant decrease in all of the studied parameters was observed in the groups by the end of the 1st week of supportive treatment and remained up to the end of the observation period (p 0.05). There were no statistically significant differences between groups 2 and 3 with respect to the acneiform rash clinical severity scale, but their values were significantly lower than those of group 1 (group 1 vs. group 2, p 0.001; group 1 vs. group 3, p 0.001). The most rapid resolution of all subjective symptoms was observed in group 3. Significantly lower mDLQI values were also observed in group 3 starting from the 1st week of supportive treatment until the end of the follow-up period (р 0.05). No severe adverse reactions were registered in any of the groups during the study. Conclusions. The developed regimens for the supportive treatment of acneiform rash have demonstrated a high efficacy in resolving papulopustular rash and associated subjective symptoms. The use of a complex approach including continuous topical therapy with ivermectin cream and hypotonic thermal water leads to the resolution of rash and relief of subjective symptoms in the shortest time, allows to safely maintain the achieved clinical effect for a long period of observation, has the most significant positive impact on the quality of life of cancer patients.