Preventive Measures Reduce Rash from Vectibix

Nearly all patients who are treated with Vectibix™ (panitumumab) will develop an itchy skin rash that looks something like acne.  However, treating the rash preemptively  before it appears reduces its severity and lengthens the time before more serious rash appears.

During the STEPP (Skin Toxicity Evaluation Protocol with Panitumumab) trial, researchers randomized patients who were being treated with Vectibix to either preemptive skin rash management at the beginning of chemotherapy or reactive treatment once rash appeared.  After six weeks, 70 percent of patients treated preemptively had not developed grade 2 skin rash.  Sixty-two percent of the reactive group already had rash that was grade 2 or higher.

Skin rash management included:

  • Moisturizers
  • Sunscreen
  • Topical steroids
  • Oral doxycycline

After six weeks of treatment, 70 percent of the preemptive group were free of grade 2 rash, while only 38 percent of the reactive group were rash-free.  In the reactive group half of patients had developed a grade 2 rash by 2.7 weeks.

More than twice as many people in the reactive group developed a more severe grade 3 rash (62 percent in reactive group versus 29 percent of the preemptive group.)

There was no increase in other side effects in the preemptive group.

Patients in the study were either treated with FOLFIRI chemotherapy and Vectibix every two weeks or Camptosar® (irinotecan) and Vectibix every three weeks.

As in other studies, benefits of Vectibix treatment were limited to patients without KRAS mutations in their tumors (wild-type).

Reflecting on the results of the STEPP study, David Chang, M.D., vice president for oncology clinical development at Amgen said,

Since skin rash is the most common side effect of EGFr therapy, the results of the STEPP trial showing that skin rash may be controlled by a relatively simple preemptive treatment, represent a significant advancement.

STEPP results were presented during the World Congress on Gastrointestinal Cancer in Barcelona, Spain.


Comments

  1. Linda Stout says

    Could you please tell me if doxycyline was used every day for the length of treatment or only as needed during treatment?
    Thank you,
    Linda

  2. says

    I think it is important to know which product worked best as there are different risks and benefits with, for example a skin moisturizer versus topical steroids or oral doxycycline.

    There are ‘natural’ or organic skin moisturizers that do not add other harmful chemicals to an already depressed immune system.

    At The Annie Appleseed Project, we favor trying the kindes, and gentlest methods FIRST.

    Ann F.
    President
    We provide information on complementary and alternative therapies for people with cancer

  3. John Morley says

    My wife has had colon cancer since end of 2002. Metastases spread throughout her abdomen and also to her liver. Since then, there have been 5 major operations and almost continuous chemo- and antibody-therapy (Avastin combined with chemo during the last year, and recently started with Vectibix alone).

    She is suffering pretty extreme skin problems after 3 Vectibix infusions. We visited the oncologist yesterday, because the itching and scratching is destroying her remaining quality of life.

    Because she was starting to have problems with vomiting and pains, which were apparently caused by new tumours in her duodenum, the Vectibix started with a relatively high dose of 500 mg every 2 weeks. This stopped the stomach problems very quickly, but then the skin problems came.

    We have heard about tetracyclin as a preemptive measure. Does anyone have information about if it works after starting Vectibix treatment? Or if there are other treatments to fight the skin problems?

    At the moment, my wife has just started taking cortisone pills to try to reduce the problem. Early days, but no effect up to now. One worry is septicaemia due to the compulsive scratching of the affected areas, which are extensive.

    Any info welcome.

  4. Kate Murphy says

    Doxycycline, which was used in the STEPP trial described above, is an derivative of oral tetracycline.

    When started after the rash appeared doxycycline in combination with steroid ointments reduced rash in about 40 percent of patients. Your wife may have more relief from the oral corticosteroids.

    Another study reported at ASCO in 2007 found that the combination of tetracycline type drugs and corticosteroids helped the majority of patients with rash. Reducing dose also was sometimes necessary.

    If your wife has not be tested for the KRAS mutation, it is important to do so.

  5. John Morley says

    Dear Kate,

    Many thanks for your rapid and helpful response.

    My wife was tested for the KRAS mutation, whose results took a couple of weeks to get back from the specialist before starting with Vectibix.

    We shall raise the point with the oncologist about possible mixtures of tetracycline and corticosteroids next week.

  6. Kate Murphy says

    We checked with the people involved in the STEPP trial and got answers to two of your questions.

    1. Doxycycline was given continuously for the first six weeks of treatment.

    2. Alcohol-free emollient creams and moisturizers were recommended and Lubriderm was called out as an example and was part of the skin care kit provided.

    Kate Murphy
    C3 Director of Research Communication

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