背景:抗表皮生长因子受体(EGFR)抗体通常会引起皮肤毒性。使用有或没有局部类固醇的全身性抗生素的预防性皮肤治疗据报道是有效的,尽管最合适的方法仍不清楚。这项研究旨在确定在现实世界的转移性结直肠癌(mCRC)治疗中,使用全身性米诺环素和局部类固醇的联合预防是否优于单独使用米诺环素。
方法:回顾性评估接受抗EGFR单克隆抗体治疗的mCRC患者(n=87)。主要目的是比较接受100mg/天预防性米诺环素的对照组在所有治疗期间≥2级总体皮肤毒性的发生率。联合预防组接受米诺环素100mg/天+局部类固醇。还评估了每种皮肤症状的发生率。
结果:对照组≥2级总体皮肤毒性的发生率为63.6%,联合治疗组为56.9%,差异无统计学意义(P=0.63)。同样,≥2级皮肤干燥的发生率,裂缝,甲沟炎,和瘙痒没有显着差异。此外,所有级别皮肤毒性的发生率没有差异.然而,组合组≥2级丘疹脓疱性皮疹的发生率显着降低(23.1%vs.50.0%,P=0.03)。倾向得分匹配分析支持这些结果。多因素logistic回归分析显示联合预防与≥2级总体皮肤毒性之间无显著关联,但它确实显示≥2级丘疹脓疱性皮疹减少。
结论:在全身性米诺环素中添加局部类固醇并不能减轻抗EGFR抗体诱导的≥2级总体皮肤毒性;然而,它显著改善丘疹脓疱性皮疹。
BACKGROUND: Anti-epidermal growth factor receptor (EGFR) antibodies often cause skin toxicities. Preemptive skin treatments using systemic antibiotics with or without topical steroid are reportedly effective although the most suitable method remains unclear. This study aimed to determine whether combination prophylaxis using systemic minocycline and topical steroid is superior to minocycline alone in a real-world metastatic colorectal cancer (mCRC) treatment.
METHODS: Patients with mCRC (n = 87) who received anti-EGFR monoclonal antibodies were retrospectively assessed. The primary objective was to compare the incidence of grade ≥ 2 overall skin toxicities during all treatment periods between the control group receiving prophylactic minocycline 100 mg/day, and the combination prophylaxis group receiving minocycline 100 mg/day + topical steroid. The incidence of each skin symptom was also evaluated.
RESULTS: The incidence of grade ≥ 2 overall skin toxicities was 63.6% in the control and 56.9% in the combination groups, with no significant difference (P = 0.63). Similarly, the incidence of grade ≥ 2 dry skin, fissures, paronychia, and pruritus did not significantly differ. In addition, incidence of all-grade skin toxicities was not different. However, the incidence of grade ≥ 2 papulopustular rashes was significantly lower in the combination group (23.1% vs. 50.0%, P = 0.03). Propensity score-matched analysis supported these results. Multivariate logistic regression analysis showed no significant association between combination prophylaxis and grade ≥ 2 overall skin toxicities, but it did show a reduction in grade ≥ 2 papulopustular rashes.
CONCLUSIONS: Adding topical steroids to systemic minocycline did not mitigate grade ≥ 2 overall skin toxicities induced by anti-EGFR antibodies; however, it significantly improved papulopustular rashes.