Purpose: The primary end-point was to describe the clinical course of monoclonal antibody-induced papulopustular rash (mAB-induced PPR), when patients alert health-care providers and the subsequent reactive measures employed. Exploring the predictors affecting PPR grading was the secondary end-point. Methods: A multicentre retrospective study involving six Italian oncology outpatient departments was conducted. Thirty-nine patients with cancer undergoing cetuximab or panitumumab treatment were included. Information was collected through medical records and face-to-face interviews. mAB-induced PPR was scored by patients' self-reported Common Terminology Criteria for Adverse Eventsv4.02 and was defined as severe when the grade ≥3. Results: Thirty-five (89.7%) patients developed a rash, which was severe in nine cases. The rash usually appeared within the first week after starting the drug (22, 62.8%), peaked in severity during the first month (26, 74.3%) and resolved 4-8 weeks after the end of mABs therapy (15, 45.7%). At the time of the interviews, the rash was not still resolved in almost half (n = 16) of the patients. Twenty-six (74.3%) patients reported sequelae and the mostly common were erythema (21, 81%) and dry skin (14, 54%). Only half of the patients informed health-care professionals as soon as the rash appeared. All the patients treated the rash topically and mAB therapy was modified in 16 (45.7%) cases (reduction, n = 10; discontinuation, n = 9; withdrawal, n = 2). No association between male gender, age, fair skin, current smokers during therapy and PPR grading escalation was found. Conclusions: The clinical course of the rash was pathognomonic. Patients should be further encouraged to communicate the onset of a rash to health-care professionals as soon as it appears to avoid grading escalation and sequelae. The adoption of CTCAE as a patient-reported outcome may become an instrument to help health-care providers in tailoring treatment measures.
Monoclonal antibody-induced papulopustular rash: Clinical course, communication to health-care professionals and reactive measures as reported by patients
Gonella, Silvia;
2016-01-01
Abstract
Purpose: The primary end-point was to describe the clinical course of monoclonal antibody-induced papulopustular rash (mAB-induced PPR), when patients alert health-care providers and the subsequent reactive measures employed. Exploring the predictors affecting PPR grading was the secondary end-point. Methods: A multicentre retrospective study involving six Italian oncology outpatient departments was conducted. Thirty-nine patients with cancer undergoing cetuximab or panitumumab treatment were included. Information was collected through medical records and face-to-face interviews. mAB-induced PPR was scored by patients' self-reported Common Terminology Criteria for Adverse Eventsv4.02 and was defined as severe when the grade ≥3. Results: Thirty-five (89.7%) patients developed a rash, which was severe in nine cases. The rash usually appeared within the first week after starting the drug (22, 62.8%), peaked in severity during the first month (26, 74.3%) and resolved 4-8 weeks after the end of mABs therapy (15, 45.7%). At the time of the interviews, the rash was not still resolved in almost half (n = 16) of the patients. Twenty-six (74.3%) patients reported sequelae and the mostly common were erythema (21, 81%) and dry skin (14, 54%). Only half of the patients informed health-care professionals as soon as the rash appeared. All the patients treated the rash topically and mAB therapy was modified in 16 (45.7%) cases (reduction, n = 10; discontinuation, n = 9; withdrawal, n = 2). No association between male gender, age, fair skin, current smokers during therapy and PPR grading escalation was found. Conclusions: The clinical course of the rash was pathognomonic. Patients should be further encouraged to communicate the onset of a rash to health-care professionals as soon as it appears to avoid grading escalation and sequelae. The adoption of CTCAE as a patient-reported outcome may become an instrument to help health-care providers in tailoring treatment measures.
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