A new study reports that epidermal growth factor (EGF) ointment is effective in managing skin toxicities and improving quality of life in patients treated with epidermal growth factor receptor (EGFR) inhibitors.
By inhibiting EGFR signaling pathways, which play a role in the pathogenesis and progression of a variety of cancers, including non-small cell lung cancer (NSCLC), pancreatic cancer, and colorectal cancer, EGFR tyrosine kinase inhibitors and anti-EGFR monoclonal antibodies are effective for cancer treatment, both alone and in combination with chemotherapy or radiation. However, the majority of patients who are treated with EGFR inhibitors experience dermatological toxicities known as EGFR inhibitor-related skin adverse events (ERSEs). These toxicities, which include acneiform rash, xerosis, paronychial inflammation, pruritis, photosensitivity, and hair and eyelash alteration, can result in physical discomfort, decreased quality of life and social functioning, and in severe cases, early discontinuation of therapy. Skin toxicities must be appropriately managed in order to optimize treatment with EGFR inhibitors.
Researchers led by first author Young Saing Kim, MD, PhD, of the Department of Internal Medicine at Gachon University's Gil Medical Center in Incheon, South Korea, conducted a placebo-controlled, double-blind phase 3 trial to evaluate the efficacy of topical EGF ointment for patients experiencing EGFR inhibitor-related skin toxicities. The trial, which was performed at 11 institutions in South Korea, enrolled 80 patients with locally advanced or metastatic NSCLC, pancreatic cancer, or colorectal cancer experiencing grade 2 or 3 ERSEs resulting from treatment with EGFR inhibitors, including gefitinib, erlotinib, afatinib, or cetuximab.
The patients were randomly assigned in a 1:1:1 ratio to receive placebo, 1 part per million (ppm) concentration of EGF ointment, or 20 ppm of EGF ointment to be applied to skin lesions twice daily. The primary end point of the study was response rate, with secondary end points of safety and quality of life.
The EGF ointment demonstrated efficacy in facilitating skin regeneration and wound healing by stimulating the proliferation and differentiation of epithelial tissue. The higher concentration of EGF ointment achieved a higher response rate, compared with the lower concentration and with placebo (77.8% vs 61.5% vs 44.4%). Response rates did not show significant differentiation based on cancer type or type of EGFR inhibitor used. Both concentrations of EGF ointment were associated with considerable improvement of quality of life compared with placebo, in terms of emotion (P=0.005) and functioning (P=0.044).
"This randomized, prospective study showed that EGF ointment was effective in treating ERSEs," conclude the researchers in their study, now published in The Oncologist. "EGF ointment had a better effect at a higher dose. Topical EGF was also associated with significant improvement of quality of life. Further research is needed to evaluate the efficacy of prophylactic use and the effect of combination therapy to obtain further evidence about the use of EGF ointment for treating ERSEs."
For More Information
Young SK, Jun HK, Oh SY, et al (2019). A randomized controlled trial of epidermal growth factor ointment for treating epidermal growth factor receptor inhibitor-related skin toxicities. Oncologist. [Epub ahead of print] DOI:10.1634/theoncologist.2019-0221
Image credit: Bruce Wetzel and Harry Schaefer