Impact of a Pre-Emptive Skin Treatment Regimen on Skin Toxicities of Anti–Epidermal Growth Factor Receptor Monoclonal Antibodies: More Questions Than Answers

Abstract

TO THE EDITOR: The Skin Toxicity Evaluation Protocol With Panitumumab (STEPP) study 1 adds to our increasing knowledge of how best to manage the sometimes troubling dermatologic adverse effects of anti– epidermal growth factor receptor monoclonal antibodies. However, it also raises numerous new questions that need to be addressed before a prophylactic treatment approach becomes a standard of care. As an example, many patients have only mild to no skin toxicity with these drugs. Is preventive therapy really needed in all? Also, the pre-emptive strategy involves four separate interventions. Could just one or two have sufficed? In addition, only one patient (2%) in the reactive treatment group received all four components of the skin treatment regimen when the patient developed a rash. Had these patients received the same protocol as the prophylactic group, would we have seen the same result? The modified Common Terminology Criteria for Adverse Events version 3.0, which was used in this study for the assessment of panitumumab-related skin adverse effects, is a subjective scale. As such, one could question if it is the most appropriate tool to quantify skin toxicity in this unblinded study setting. Finally, severity of rash is highly correlated with the efficacy of these agents. 2-4 Can we be certain this effect will remain in the face of a prophy