Tips on managing the rash associated with EGFR inhibitors
Source: OncologySTAT (www.oncologystat.com) Author: OncologySTAT Editorial Team Nurses at Duke University Hospital in Durham, NC, have developed a treatment algorithm for the rash that frequently occurs with use of epidermal growth factor receptor (EGFR) inhibitors. “We want to help sustain patients so they can continue to get their therapy and maintain their quality of life,” Kimberly Bishop, RN, BSN, OCN, said at the Oncology Nursing Society 34th Annual Congress. For mild rash that doesn’t affect activities of daily living or quality of life, the algorithm recommends a topical cream—hydrocortisone and/or clindamycin or metronidazole. “At our institution, we use MetroCream [metronidazole cream] as our primary topical agent,” Ms. Bishop said. For moderate rash, an oral antibiotic is added, most commonly doxycycline 100 mg twice daily. “We reassess [patients] every 2 weeks to see what the rash looks like, and encourage patients to call to let us know if there is a change in the rash,” she said. Ms. Bishop described the rash as very red, often starting as a macular reaction and progressing to a pustular abscess-like rash that becomes ulcerated. “The rash itself is not infectious but can lead to a secondary superinfection from scratching. That’s why antibiotic therapy is important,” she said. For severe rash, the recommendation is to hold the EGFR inhibitor therapy and reassess within 1 to 2 weeks, continue with the antibiotic, and also add a Medrol Dosepak (oral methylprednisolone packaged to provide a tapering dose). Ms. Bishop warned that “any time you put steroid cream [...]