Prophylactics reduced skin-related toxicities due to panitumumab

2009 Gastrointestinal Cancers Symposium

Patients assigned to pre-emptive skin therapies including moisturizers and topical steroids experienced a greater than 50% reduction in grade-2 or higher skin toxicities related to treatment with panitumumab, according to results from the STEPP trial.

Skin toxicities are a common side effect for patients being treated with panitumumab (Vectibix, Amgen). Edith Mitchell, MD, a clinical professor and program leader for gastrointestinal oncology at Thomas Jefferson University in Philadelphia, and colleagues tested whether initiating treatments prior to chemotherapy would reduce the incidence of skin toxicities.

“We saw that if we initiated this therapeutic regimen prior to the initiation of panitumumab treatment it could decrease the inflammatory reaction and therefore the more serious toxicities,” Mitchell said. “We could not totally prevent toxicities, but we did reduce the number of grade-2 or higher toxicities.”

Researchers at multiple centers assigned 48 patients to pre-emptive skin treatment and 47 patients to reactive treatments. The treatments included moisturizers, sunscreen, 1% hydrocortisone cream and doxycycline.

All patients in the study were being treated with panitumumab for metastatic colorectal cancer.

Fourteen patients in the pre-emptive group experienced grade-2 or higher skin toxicities vs. 29 patients in the reactive group (OR=0.3; 95% CI, 0.1-0.6). Patients in the pre-emptive group also received more doses of panitumumab during the six-week study period (155 vs. 141) and only one patient had dose delays compared with nine patients in the reactive group. – by Jason Harris

Skin toxicity is a major issue with the use of anti-EGFR monoclonal antibodies. The concern is that if the toxicity is severe, patients could be unwilling to continue treatment and could stop treatment that may benefit them. This study represents a very interesting attempt at reducing the rate of the toxicity. I think the idea is very creative, skin toxicity is certainly a problem we all have and this is a potential step forward, but I don’t think these results are conclusive at this point.

– Robert J. Mayer, MD

Director, Center for Gastrointestinal Oncology,
Dana-Farber Cancer Institute

For more information:
Lacouture ME. #291. Presented at: the 2009 Gastrointestinal Cancers Symposium; Jan. 15-17, 2009; San Francisco.