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Doxycycline Prophylaxis in Adolescent Patients Treated With MEK Inhibitors

Faith Cormier1, Irene Lara-Corrales1, Rebecca Levy1

  • 1The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.

Pediatric Dermatology
|May 29, 2025
PubMed

Insights

Doxycycline prophylaxis did not significantly reduce acneiform eruptions in young patients on mitogen-activated protein kinase inhibitors (MEKi). However, it was linked to fewer treatment discontinuations and less paronychia.

Area of Science:

  • Oncology
  • Dermatology
  • Pharmacology

Background:

  • Mitogen-activated protein kinase inhibitors (MEKi) are crucial in treating plexiform neurofibromas, brain tumors, and cancers.
  • Acneiform eruptions and paronychia are common, dose-limiting toxicities associated with MEKi therapy.
  • Preventive strategies for MEKi-induced skin toxicities are needed to improve patient adherence and outcomes.

Purpose of the Study:

  • To evaluate the efficacy of doxycycline prophylaxis in mitigating acneiform eruptions and paronychia in pediatric patients receiving MEKi.
  • To assess the impact of doxycycline on MEKi treatment discontinuation rates due to skin toxicities.

Main Methods:

  • Retrospective study of 43 patients (aged 12-18 years) treated with MEKi between 2010 and 2023.
  • Data collected on the incidence and severity of acneiform eruptions (CTCAE grading) and paronychia.
  • Comparison of outcomes between patients receiving doxycycline prophylaxis and those who did not.

Main Results:

  • Doxycycline prophylaxis did not significantly alter the frequency or severity of acneiform eruptions.
  • A trend towards fewer MEKi discontinuations due to skin toxicities was observed in the doxycycline group.
  • Doxycycline prophylaxis was associated with a statistically significant decrease in the rates of paronychia.

Conclusions:

  • Doxycycline may not be effective in preventing MEKi-induced acneiform eruptions but could help manage paronychia.
  • Prophylactic doxycycline might reduce treatment interruptions, potentially improving therapeutic efficacy.
  • Further prospective studies are warranted to confirm these findings and optimize supportive care for MEKi therapy.

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