Oral Minocycline Reduces Cetuximab-Associated Papular Rash

By Will Boggs, MD

NEW YORK DEC 25, 2007 (Reuters Health) - Oral minocycline prophylaxis decreases the severity of the acne-like eruption that affects many patients being treated for metastatic colorectal carcinoma with the epidermal growth factor receptor (EGFR) inhibitor cetuximab, according to a report in the December 1st issue of the Journal of Clinical Oncology.

"Although highly distressing to patients, the cutaneous side effects of anti-EGFR therapy can be adequately controlled to permit continuation of therapy," Dr. Allan C. Halpern from Memorial Sloan-Kettering Cancer Center, New York told Reuters Health.

Dr. Halpern and associates evaluated the potential of oral minocycline and a topical retinoid (tazarotene) to prevent cetuximab-associated acneiform rash in 48 patients with stage IV colorectal cancer. Patients were randomized to oral minocycline or oral placebo, along with open-label tazarotene applied to one side of the face, beginning in the same day as initiation of cetuximab.

Lesion counts were significantly lower in patients treated with minocycline than in patients treated with placebo, the authors report. Patients treated with minocycline were also less likely than placebo patients to report moderate to severe itch and rash.

Treatment differences emerged as early as week 1, peaked at study weeks 2 and 4, and tapered by week 8 (study conclusion), the report indicates.

In contrast, the investigators say, tazarotene had no consistent benefit. Many patients discontinued the drug as a result of local irritation, and facial photography revealed no differences between treated and untreated sides in 87% of patients and a worse rash on the tazarotene side in 10% of patients.

"I would use (minocycline) for 8 weeks at first sign of significant papular dermatitis, thus avoiding treatment in patient with very minimal or no rash," Dr. Halpern advised. "Psychosocial support for patients dealing with rash, let alone their disease, is critical to successful therapy," he added.

"Topical tazarotene showed no clinical benefit and some evidence of detriment, suggesting that it has no role in the management of cetuximab-related skin rash," the researchers note. "We are currently completing a study on the use of topical Elidel (pimecrolimus) to treat established anti-EGFR rash," Dr. Halpern commented.

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