Cutaneous manifestations of new oncologic drugs: epidermal growth factor receptor inhibitors and 5-fl uorouracil prodrugs

Abstract: Novel oncologic drugs are currently available for the treatment of solid tumors, with high incidence of dermatologic adverse reactions. Capecitabine is a systemic prodrug of 5 fl uorouracil, which is prescribed in metastatic colorectal and breast carcinoma and produces hand-foot syndrome (or erythrodysesthesia) and skin pigmentation. Cetuximab is a monoclonal antibody against epidermal growth factor receptor (EGFR). The skin toxicity includes follicular eruption, paronychia and hair abnormalities. This eruption has been associated with increased survival of the patients. We present 6 patients who are under treatment with these drugs. Four of them take capecitabine as monotherapy or combined with other agents and present several stages of hand-foot disease, nail dystrophy and abrupt appearance of lentiginous lesions on palms and soles. The histopathology of these pigmentary lesions shows basal hyperpigmentation with a lentiginous pattern. The other two patients receive cetuximab for colorectal cancer and present sudden onset of typical acneiform eruption on trunk, face and scalp, and have lately developed several levels of nail dystrophy and hair alterations. The treatment of these cases is symptomatic, not standardized, and only requires diminishing the doses of the drugs in a few cases. Seldom is it necessary to terminate its use. We deem these cases to be important to present since it is necessary for dermatologists to be aware of the existence of these adverse reactions enabling diagnosis and correct management of them. As well we would like to emphasize the description of eruptive lentiginosis and hair abnormalities which are rarely found in current literature (Dermatol Argent 2008;14(4):276-280) Keywords: cetuximab, capecitabine, epidermal growth factor, eruptive nevi, acneiform eruption.