INDIVIDUAL ARTICLE: USCOM IV Algorithm for the Prevention and Management of Targeted Therapy-Related Cutaneous Adverse Events
December 2024 | Volume 23 | Issue 12 | 436613s3 | Copyright © December 2024
Published online November 25, 2024
Jonathan Leventhal a, Ana Sofia Acosta Madiedo MDb, Anneke Andriessen PhDc, Jennifer N Choi MDd, Alice Ho MD MBAe, Beth McLellan MDf, Edith Mitchell MDg †, Mario Lacouture MD FAADh
aOnco-Dermatology Program, Smilow Cancer Hospital, Yale New Haven, New Haven, CT
bMount Sinai Medical Center, Miami Beach, FL
cRadboud UMC Nijmegen and Andriessen Consultants, Malden, The Netherlands
dDivisions of Oncodermatology and Medical Dermatology, Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg, School of Medicine, Chicago, IL
eBreast Clinical Research Unit, Duke Cancer Institute, Radiation Oncology, Durham, NC
fDermatology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Montefiore-Einstein Cancer Center, Bronx, NY
gDepartment of Medical Oncology, Center to Eliminate Cancer Disparities, Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA
hDermatology, NYU Grossman Long Island School of Medicine, Mineola, NY
†passed prior to publication.
Abstract
Introduction: Targeted therapy has improved clinical outcomes for various types of cancer. However, their use is associated with dermatologic adverse events that impact quality of life and consistent therapies.
Objectives: The US Cutaneous Oncodermatology Management (USCOM) multidisciplinary-guided algorithm for preventing and managing cutaneous targeted therapy-related adverse events provides practical recommendations for cancer patients and survivors.
Methods: The USCOM advisory board (panel) identified 6 commonly occurring cutaneous adverse events associated with targeted therapies. Practical recommendations for prevention and management were developed based on the results of a literature search, clinical expertise, and opinion.
Results: Acneiform rash, pruritus, xerosis, paronychia, hyperpigmentation, and hand-foot skin reaction were selected as common targeted therapy-related cutaneous adverse events. The panel provides practical steps for preventing and treating these cutaneous conditions.
Conclusions: The USCOM multidisciplinary-guided algorithm is for healthcare providers treating oncology patients receiving targeted therapies. Cutaneous targeted therapy-related adverse events necessitate prompt and accurate diagnosis and multidisciplinary management that includes a dermatologist and the oncologic team, limiting disruption of cancer treatment and optimizing quality of life and treatment outcomes.
J Drugs Dermatol. 2024;23:12(Suppl 1):s3-14.
INTRODUCTION
In 2023, an estimated 1,958,310 Americans were diagnosed with cancer.1 Although overall incidence continues to rise, ongoing advancements in anticancer therapy have improved survival. Some historically fatal malignancies are treated as chronic diseases, and progress in the discovery of new targets and drugs has exposed patients to a new spectrum of drug toxicities both from novel agents as well as the extended duration of use.1-4
Targeted therapy-related cutaneous adverse events (TTcAEs) frequently occur and vary in severity depending on the drug and patient population. In oncology, targeted therapy (TT) has revolutionized cancer treatment by specifically targeting molecules or pathways crucial for cancer cell growth and survival, distinct from the cytotoxic effects of traditional chemotherapy. TT inhibits specific receptors (eg, Epidermal Growth Factor Receptor (EGFR) inhibitors, Human EGFR receptor 2 (HER2) inhibitors, or intracellular kinases (eg, Proto-oncogene B-Raf (BRAF) inhibitors, mitogen-activated protein kinase kinase (MEK) inhibitors), disrupting signaling cascades essential for tumor proliferation or interfering with angiogenesis. TT offers enhanced efficacy with reduced systemic toxicity.5-10 The overall percentage of cancers treated with TT increases as more agents are developed. TT is commonly used to treat certain types of cancer, including breast cancer (BC), especially HER-2 positive BC, non-small cell lung cancer (NSCLC), colorectal cancer, melanoma, chronic myeloid leukemia, lymphoma, and renal cell carcinoma.5-10
