Adverse skin reactions during treatment with cetuximab plus radiotherapy: Multidisciplinary approach to minimize radio-chemotherapy interruption

J Dermatolog Treat. 2015 Apr;26(2):183-7. doi: 10.3109/09546634.2014.927815. Epub 2014 Jun 17.


Background: Antibodies against the epidermal growth factor receptor (EGFR), such as cetuximab, are effective in loco-regional advanced squamous cell carcinoma of the head and neck (SCCHN) in association with radiotherapy. Cutaneous reactions are well known as adverse events during treatment with EGFR inhibitors.

Objective: To identify a multidisciplinary approach for mucous-cutaneous toxicity during cetuximab-radiotherapy treatment in order to reduce the risk of an early radio-chemotherapy interruption.

Methods: The data of 38 patients with SCCHN receiving cetuximab and radiotherapy were retrospectively analyzed. The control group (n = 15) received the standardized treatments according to the severity of skin reactions with dermatologic visits only for high degrees of toxicity. The experimental group (n = 23) was monitored and daily treated by dermatologists since grade 1 of cutaneous toxicity. The primary end-point of our study was the mean days of antitumor therapy interruption.

Results: The mean number of days of antitumor therapy suspension was 12.6 (7.6) in the standard treatment group and 5.0 (6.6) in the experimental group (p = 0.002). This difference was observed for each grade of toxicity.

Conclusion: The early interruption of radio-chemotherapy has a negative impact on survival in patients with SCCHN. In our study, a closer dermatological examination and treatment for all degrees of toxicity reduced early interruptions of chemo-radiotherapy.

Keywords: Cetuximab; EGFR inhibitors; papulo-pustular rash; radiotherapy; squamous cell carcinoma of head and neck.

MeSH terms

  • Aged
  • Antineoplastic Agents / administration & dosage*
  • Antineoplastic Agents / adverse effects
  • Carcinoma, Squamous Cell / therapy*
  • Cetuximab / administration & dosage*
  • Cetuximab / adverse effects
  • Combined Modality Therapy
  • ErbB Receptors / immunology
  • Female
  • Head and Neck Neoplasms / therapy*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Squamous Cell Carcinoma of Head and Neck


  • Antineoplastic Agents
  • EGFR protein, human
  • ErbB Receptors
  • Cetuximab