Cutaneous adverse reactions to molecular targeted antitumor drugs and their management

Abstract

There are three kinds of molecular targeted antitumor drugs: inhibitors of membrane-associated therapeutic targets, inhibitors of intracellular signaling pathways, and immunomodulators. Inhibitors of membrane-associated therapeutic targets include epidermal growth factor receptor inhibitors (EGFRIs), KIT and BCR-ABL inhibitors, antiangiogenic agents and multikinase inhibitors. Inhibitors of intracellular signals include inhibitors of the RAS-RAF-MEK-ERK pathway, PI3K-AKT-mTOR pathway and Hedgehog signaling pathway. Inhibitors of cytotoxic T lymphocyte associated-antigen (CTLA)and programmed death 1 (PD-1)belong to immunomodulatory agents. Cutaneous adverse effects of different molecular targeted antitumor drugs share some common features, but also differ from each other. Most of the side effects are dose-dependent and reversible. Management strategies should be adjusted according to the severity of skin eruptions. Dose tapering and even discontinuation of antitumor drugs are necessary for very severe cases, but for mild ones, symptomatic treatment might be enough. This article reviews cutaneous adverse reactions to molecular targeted therapy as well as their prevention and management. Key words: Molecular targeted therapy; Antineoplastic agents; Drug toxicity; Skin manifestations