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Research Letter
March 2016

Comparison of Skin Toxic Effects Associated With Gefitinib, Erlotinib, or Afatinib Treatment for Non–Small Cell Lung Cancer

Author Affiliations
  • 1Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei
  • 2Department of Oncology, National Taiwan University Hospital, Taipei
  • 3Department of Urology, National Taiwan University College of Medicine, Taipei
  • 4Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City
JAMA Dermatol. 2016;152(3):340-342. doi:10.1001/jamadermatol.2015.4448

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have been widely used to treat non–small cell lung cancer. Four major skin toxic effects with different incidences have been reported from clinical studies, including acneiform eruption (60%-94%), pruritus (16%-60%), xerosis (4%-38%), and paronychia (6%-12%).1,2 However, a direct comparison of the incidences and severities of the 4 types of skin toxic effects for 3 different EGFR-TKIs in the same patient cohort has been lacking to date.

This retrospective study was approved by the research ethics committee of National Taiwan University Hospital. We recruited patients within a named patient program for compassionate use before registration who had ever received afatinib treatment for non–small cell lung cancer between November 1, 2007, and April 30, 2013. Most of the patients had received gefitinib or erlotinib hydrochloride treatment before commencing afatinib therapy, although some patients had been prescribed afatinib as their first EGFR-TKI. The dates of our study analysis were November 1, 2013, to December 30, 2014. The inclusion criteria for the present analysis were (1) EGFR-TKI exposure for at least 30 consecutive days, (2) a minimum 30-day washout interval between each drug exposure if 2 or more EGFR-TKIs were used, and (3) clinical follow-up for at least 6 months. Any skin toxic effects occurring during each of the EGFR-TKI exposure periods that fulfilled the inclusion criteria were reviewed retrospectively. A χ2 test was used to compare the incidences of skin toxic effects for the different EGFR-TKIs. An unpaired 2-tailed t test was used to compare the number of dermatologic visits during the first 180 days of each drug exposure. P ≤ .05 was considered statistically significant.