予防的治療により重度の薬剤性発疹の発現を減らすことができる （Abstract #: CRA4027）

予防的なクリームおよび抗生剤投与により大腸がん分子標的治療薬に一般的に見られる重度の発疹の発現を減少させることができる
Prophylactic creams and antibiotics reduce common, severe skin rash associated with targeted colon cancer drug
大腸がん患者にpanitumumabを投与する前に保湿剤、日焼け止め、ステロイド軟膏および経口抗生剤を処方することにより重度の発疹の発現が半数以上減少すると第45回American Society of Clinical Oncology学会で発表された。Panitumumabを投与された約90%の患者およびセツキシマブを投与された患者の最大75%に有意なざ瘡様発疹が出現する。この発疹は美容上問題となるだけでなく治療を遅延させるほどの重篤な皮膚感染症を引き起こしうる。このスタディでは、panitumumabベースの治療開始24時間前に6週間の予防的皮膚処置（保湿剤、日焼け止め、ステロイド軟膏およびドキシサイクリン）を試行する群に無作為に割り付けられた転移性大腸がん患者48人と、発疹が発現してから治療を開始する群に割り付けられた患者47人における皮膚毒性を比較した。予防的治療群患者においては29%に皮膚毒性が認められたのに対し、発疹が出現して治療を開始した群では62%に認められた。予防的治療群の患者はまた、外見上も身体的にも快適でありライフスタイルを大きく改善する必要もないことから、QOLの点でも良好であると報告している。
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Giving patients with colon cancer a combination regimen consisting of moisturizers, sunscreen, topical corticosteroids and oral antibiotics before they receive panitumumab reduces the incidence of a severe skin rash by more than half according to research presented at the 45th Annual Meeting of the American Society of Clinical Oncology. In addition, it has a significant impact on patients' quality of life, and decreases delays in receiving therapy, which could potentially impact cancer outcomes.

Panitumumab belongs to a class of drugs known as epidermal growth factor receptor (EGFR) inhibitors.

"The skin toxicity caused by EGFRs like panitumumab and cetuximab can be devastating for patients. It prevents many patients from agreeing to take these drugs and either delays or interrupts treatment for many others, reducing the effectiveness of therapy," explained Edith Mitchell, M.D., clinical professor of medicine and medical oncology at Thomas Jefferson University in Philadelphia and the study's lead author. "Prophylactic skin treatment is likely to become a new standard of care for patients receiving these drugs."

About 90 percent of patients receiving panitumumab and up to 75 percent of those who take cetuximab develop a significant acne-like rash that is not only cosmetically unattractive, but can lead to serious skin infections causing delays in treatment. The rash develops because these drugs target the epidermal growth factor receptor, which is found in very high amounts in the skin.

In this study, skin toxicity was compared between 48 patients with metastatic colorectal cancer who were randomly assigned to receive prophylactic skin treatment (moisturizers, sunscreen, topical steroids and the antibiotic doxycycline) for six weeks starting 24 hours before panitumumab-based therapy and 47 patients whose skin was not treated until after the rash developed.

Twenty-nine percent of those in the prophylactic group experienced skin toxicity versus 62 percent of those in the delayed treatment group. Patients who received the prophylactic skin treatment also reported better quality of life than those whose rash was not treated until after it developed because they felt better about their appearance and were more physically comfortable, with less impairment of their lifestyle.