Cutaneous adverse reactions caused by epidermal growth factor receptor inhibitions: clinical manifestation, prevention and management

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The target of epidermal growth factor receptor inhibitor (EGFRI) is epidermal growth factor receptor (EGFR). EGFRI can block the activation and signal transduction of EGFR in tumor cells, inhibit the proliferation of tumor cells and induce apoptosis, thus having antineoplastic effect. EGFRIs are currently widely used as targeted anti-tumor drugs. EGFRI can act on skin keratinocytes, interfering with the growth, proliferation, differentiation, migration and adhesion of keratinocytes, causing growth arrest and premature differentiation of the keratinocytes in the basal layer, and often leading to adverse skin reactions. The incidence of EGFRI-related cutaneous adverse reactions was 40% to 90%. Common cutaneous adverse reactions include papulopustular rash, skin pruritus, dry skin, skin cracking, angiotelectasis, and changes of hair and nails. Most cutaneous adverse effects are reversible and dose-dependent. The incidence and severity of adverse skin reactions are closely related to the clinical efficacy of EGFRI. Therefore, the adverse skin reactions should be correctly recognized and should be managed separately according to the severity of the reactions. In general, grade 1 and grade 2 adverse skin reactions need not withdrawal or dosage adjustment of EGFRI, but severe adverse skin reactions may affect the patients' quality of life, so EGFRI dosage should be reduced or discontinued, and EGFRI retreatment should be continued when the skin damage is improved. Key words: Antineoplastic agents; Epidermal growth factor receptor; Drug-related side effects and adverse reactions; Drug eruptions