Article and Video CATEGORIES

Cancer Journey

Search By

Dr. Jack West is a medical oncologist and thoracic oncology specialist who is the Founder and previously served as President & CEO, currently a member of the Board of Directors of the Global Resource for Advancing Cancer Education (GRACE)

 

More Info on the Correlation of Rash with Outcome on EGFR Inhibitors: My Changing View in Light of the TOPICAL Trial

Please Note: New Treatments Have Emerged Since this Original Post
Author
Howard (Jack) West, MD

There's been a theme with the inhibitors of the epidermal growth factor receptor (EGFR) -- both oral tyrosine kinase inhibitors (TKIs) and IV monoclonal antibodies -- that the patients who demonstrate good results with these agents tend to get a rash, while the patients who don't get a rash do poorly.  We've even got an FAQ discussion of the association of rash and outcome on EGFR inhibitor therapy. That result has been seen in post-hoc analyses of the results in several trials, and not just in lung cancer, but I've been very reluctant to use this concept in my own clinical decision making. Why? A number of reasons. These are just a post-hoc analyses. Tarceva (erlotinib) is FDA approved for all previously treated patients with advanced NSCLC.  You need to try the drug to know if a patient is going to get a rash.  And importantly, some patients do extremely well with EGFR inhibitors despite not developing skin side effects.

Nevertheless, the recent results from the TOPICAL study, just published in the journal Lancet Oncology, adds more firepower to the argument that the question of whether a patient on an EGFR inhibitor develops a rash should be a factor in deciding whether to continue it. Specifically, the results suggest that patients who don't develop a rash in the first month on Tarceva do worse than the patients on placebo . Here's a brief video that describes the work:

[powerpress]

So here's my question: if you or someone you care for were inclined to try Tarceva but didn't develop a rash, would you stop it after a trial period of four weeks or so, or would you still want to refill the prescription for another month or two before a scan clarifies whether there is progression or not?  Would you accept the concept that the development of rash may distinguish between those helped and those potentially even harmed from an EGFR inhibitor?

I think it may be time for me to update my perspective on the FAQ.

Next Previous link

Previous PostNext Post

Related Content

Article
The journey to conquer lung cancer is paved with scientific discovery, and the identification of the EGFR and ALK genes as crucial players marks a significant milestone. Unraveling how mutations in these seemingly small segments of our DNA can unleash the destructive force of cancer has opened up exciting new therapeutic avenues. This exploration delves into the cutting-edge world of EGFR and ALK-targeted therapies, highlighting the progress made and the ongoing quest for even more effective and personalized strategies to combat this formidable disease.
Image
Rare cancers
Video
In these videos,  Dr. Jared Weiss gives a brief overview of NUT Carcinoma, discusses treatment options and possible future treatment.  To watch the complete playlist, click here.  
Article
Don't let the word "small" deceive you. Small cell lung cancer (SCLC) casts a long shadow, impacting lives with its aggressive nature and the complexities of its treatment. But while the challenges are real, so is the progress. Breakthroughs in small cell lung cancer treatment offer hope. Immunotherapy plus chemo-radiation improves survival by 22 months. Screening catches it early.

Forum Discussions

Can SCLC also be treated with targeted therapy?

Hi amitchouhan,

Welcome to Grace. At this time, there aren't any targeted therapies to treat SCLC, but there are new treatments. Check out our latest OncTalk webinar from December. The last...

I was searching for this, Thank you so much for the info.

Recent Comments

JOIN THE CONVERSATION
Yes, it's crucial to discuss…
By JanineT GRACE … on
Definitely a good idea to…
By OakleeFarnick on
Thank you for sharing
By LeviDrake on
Hi bluesun,I don't know of…
By JanineT GRACE … on