Drug eruptions with novel targeted therapies - immune checkpoint and EGFR inhibitors

Area of Science:

• Dermatology
• Oncology
• Pharmacology

Background:

• Novel targeted therapies, including immune checkpoint inhibitors and epidermal growth factor receptor (EGFR) inhibitors, are increasingly used for cancer treatment.
• These therapies are associated with a distinct spectrum of cutaneous adverse events that pose diagnostic and management challenges for dermatologists.
• Understanding these side effects is crucial for maintaining patient quality of life and preventing interruptions in cancer therapy.

Purpose of the Study:

• To review the spectrum of cutaneous adverse events associated with immune checkpoint inhibitors and EGFR inhibitors.
• To highlight diagnostic challenges, particularly for exanthematous drug eruptions.
• To outline current management strategies for these therapy-related skin toxicities.

Main Methods:

• Literature review of cutaneous side effects associated with immune checkpoint inhibitors and EGFR inhibitors.
• Discussion of diagnostic approaches, including skin biopsy for severe or atypical cases.
• Overview of treatment modalities, including topical and systemic corticosteroids, antibiotics, and tetracyclines.

Main Results:

• Immune checkpoint inhibitors can cause various immune-related exanthemas, such as maculopapular, lichenoid, and psoriasiform eruptions, and may unmask autoimmune conditions.
• EGFR inhibitors frequently cause papulopustular eruptions, affecting up to 90% of patients early in treatment.
• Topical/systemic steroids are primary treatments for immune-related eruptions, while topical antibiotics, steroids, and oral tetracyclines are key for EGFR inhibitor-induced papulopustular eruptions.

Conclusions:

• Dermatologists must be adept at recognizing and managing novel cutaneous side effects from targeted cancer therapies.
• Early and accurate diagnosis, alongside appropriate management, is essential to mitigate patient morbidity and treatment disruption.
• Specific treatment protocols exist for different classes of targeted therapy-induced skin toxicities, emphasizing corticosteroids and tetracyclines.