This Article Full Text Full Text (PDF) All Versions of this Article: theoncologist.2008-0149v1 13/11/1201    most recent eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jatoi, A. Articles by Nguyen, P. L. Search for Related Content PubMed PubMed Citation Articles by Jatoi, A. Articles by Nguyen, P. L.

Symptom Management and Supportive Care

Do Patients Die from Rashes from Epidermal Growth Factor Receptor Inhibitors? A Systematic Review to Help Counsel Patients About Holding Therapy

^aDepartment of Oncology and ^bDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA

Key Words. Epidermal growth factor receptor inhibitors • Death • Rash • Clinical trials • Toxicity

Correspondence: Aminah Jatoi, M.D., 200 First Street SW, Rochester, Minnesota 55905, USA. Telephone: 507-284-3902; Fax: 507-284-3902; e-mail: jatoi.aminah{at}mayo.edu

Received July 14, 2008; accepted for publication October 16, 2008; first published online in THE ONCOLOGIST Express on November 6, 2008.

Disclosure: The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers.

Rash from epidermal growth factor receptor inhibitors is common and negatively impacts the quality of life of cancer patients. Published guidelines recommend holding cancer therapy if the rash is severe. Does this recommendation hinge solely on improving patients' quality of life, or does it also hinge on the prevention of a potentially fatal, cutaneous adverse event? In other words, do patients die from rashes from epidermal growth factor receptor inhibitors? To our knowledge, the latter question has never before been asked and answered in an evidence-based fashion. Therefore, we conducted a systematic review of the published, prospectively conducted clinical trial literature on epidermal growth factor receptor inhibitors. The primary aim was to determine whether rash-related death has ever been reported in such trials. Among 117 such trials, which included 8,998 cancer patients, the rate of rash development was >50%, as expected. However, there were no reported deaths from a rash. Although we cannot conclude that a rash-related death from this class of agents can never occur, this systematic review provides evidence-based guidance on how best to counsel cancer patients who develop a rash from an epidermal growth factor receptor inhibitor. It suggests that quality of life issues should remain at the forefront as cancer patients and health care providers make decisions about holding cancer therapy.