Risk of anti-EGFR monoclonal antibody-related skin rash: an up-to-date meta-analysis of 25 randomized controlled trials

Abstract

Purpose:To assess the risk of severe skin rash in cancer patients treated with anti-epidermal growth factor receptor (EGFR)-monoclonal antibodies (MoAbs).Methods:Databases from PubMed, Web of Science, and abstracts presented at American Society of Clinical Oncology (ASCO) meeting up to 31 June 2013 were searched to identify relevant studies. Eligible studies included prospective randomized controlled trials (RCTs) evaluating MoAbs in cancer patients with adequate data on skin rash and/or acne-like skin rash.Results:A total of 14 270 patients from 25 RCTs were included. The overall incidences of all-grade and high-grade rash were, respectively, as follows: skin rash – 55·4 and 10·5%, and acne-like skin rash – 71·9 and 13·3%. Patients who received MoAbs significantly increased the risk of developing all-grade and high-grade skin rash and acne-like skin rash. Meta-regression indicated that the odds ratio (OR) of high-grade skin rash tended to be higher in the study in which the MoAbs treatment was longer. Additionally, similar results were observed in prespecified subgroup analysis.Conclusions:In patients with advanced solid tumors, EGFR-MoAbs are associated with an increased risk of developing skin rash and acne-like skin rash, and the risk tends to be associated with EGFR-MoAbs treatment duration. Adequate monitoring and early intervention are recommended to prevent decreased quality of life (QoL) and inconsistent dosing.