Format

Send to

Choose Destination
Int J Radiat Oncol Biol Phys. 2016 Aug 1;95(5):1346-1354. doi: 10.1016/j.ijrobp.2016.03.011. Epub 2016 Mar 26.

Correlation Between the Severity of Cetuximab-Induced Skin Rash and Clinical Outcome for Head and Neck Cancer Patients: The RTOG Experience.

Author information

1
Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: voichita.bar-ad@jefferson.edu.
2
NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania.
3
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
4
Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
5
University of Texas M. D. Anderson Cancer Center, Houston, Texas.
6
H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
7
Radiological Associates of Sacramento, Sacramento, California.
8
Virginia Mason Medical Center, Seattle, Washington.
9
Mayo Clinic, Rochester, Minnesota.
10
University of Colorado Comprehensive Cancer Center, Denver, Colorado.
11
McGill University, Montreal, Quebec, Canada.
12
University of Alabama at Birmingham, Birmingham, Alabama.
13
Stanford University Medical Center, Stanford, California.

Abstract

PURPOSE:

To evaluate the severity of cetuximab-induced skin rash and its correlation with clinical outcome and late skin toxicity in patients with head and neck squamous cell carcinoma treated with chemoradiation therapy and cetuximab.

METHODS AND MATERIALS:

Analysis included patients who received loading dose and ≥1 cetuximab dose concurrent with definitive chemoradiation therapy (70 Gy + cisplatin) or postoperative chemoradiation therapy (60-66 Gy + docetaxel or cisplatin).

RESULTS:

Six hundred two patients were analyzed; 383 (63.6%) developed grade 2 to 4 cetuximab rash. Patients manifesting grade 2 to 4 rash had younger age (P<.001), fewer pack-years smoking history (P<.001), were more likely to be males (P=.04), and had p16-negative (P=.04) oropharyngeal tumors (P=.003). In univariate analysis, grade 2 to 4 rash was associated with better overall survival (hazard ratio [HR] 0.58, P<.001) and progression-free survival (HR 0.75, P=.02), and reduced distant metastasis rate (HR 0.61, P=.03), but not local-regional failure (HR 0.79, P=.16) relative to grade 0 to 1 rash. In multivariable analysis, HRs for overall survival, progression-free survival, distant metastasis, and local-regional failure were, respectively, 0.68 (P=.008), 0.85 (P=.21), 0.64 (P=.06), and 0.89 (P=.48). Grade ≥2 rash was associated with improved survival in p16-negative patients (HR 0.28 [95% confidence interval 0.11-0.74]) but not in p16-positive patients (HR 1.10 [0.42-2.89]) (P=.05 for interaction). Twenty-five percent of patients with grade 2 to 4 acute in-field radiation dermatitis experienced grade 2 to 4 late skin fibrosis, versus 14% of patients with grade 0 to 1 acute in-field radiation dermatitis (P=.002).

CONCLUSION:

Grade 2 to 4 cetuximab rash was associated with better survival, possibly due to reduction of distant metastasis. This observation was noted mainly in p16-negative patients. Grade 2 to 4 acute in-field radiation dermatitis was associated with higher rate of late grade 2 to 4 skin fibrosis.

Comment in

PMID:
27212198
PMCID:
PMC5199017
DOI:
10.1016/j.ijrobp.2016.03.011
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center