Meta-analysis and systematic review of the role of preemptive oral antibiotics and topical vitamin K for acneiform rash induced by EGFR-targeted therapies.

Abstract

e13646 Background: Acneiform rash (AR) is the most frequent adverse event associated with epidermal growth factor receptor (EGFR) inhibitors, which are widely used to fight solid tumors. Multiple trials studied prophylactic measures to help prevent the incidence and severity of this skin toxicity. The aim of this systematic review and meta-analysis (MA) was to analyze the clinical efficacy of the two most studied prevention strategies to mitigate the severity of skin rash induced by EGFR inhibitors. We sought to understand the current role of oral antibiotics and topical vitamin K in this scenario. Methods: A wide search through electronic databases and congress abstracts was performed. Studies with control groups reporting the pre-emptive role of both oral antibiotics and topical vitamin K were selected for two separate MA. Overall incidence and severity of AR were the analyzed dichotomous outcomes. Results: Fourteen studies (n=1085) were included in the antibiotics MA. Antibiotics prevented both moderate to severe (OR 0.38; CI 95% 0.24-0.60) and all-grade AR (OR 0.55; CI 95% 0.39-0.78). Four studies (n=507) were selected for the vitamin K MA. No benefit in the prevention of grade ≥ 2 AR was observed for this topic agent in the prophylactic setting (OR 1.21; CI 95% 0.79-1.85). Conclusions: There is still need to seek more efficacious ways to manage skin toxicities associated with EGFR inhibitors since this can impair quality of life and cancer treatment adherence. The use of oral antibiotics should be more encouraged as a prophylactic measure in the current guidelines.