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Rashes mean longer survival for
cancer patients
July 13, 2007
Rashes following treatments for
cancer could well be a great sign! The
unpleasant acne like eruptions in
cancer patients treated with certain
newer generation drugs is indicative
that the patient will survive longer.
Often, patients are forced to consider
discontinuing treatments thinking that
irritating rashes are due to some
adverse reaction of the drug.
But “it is important for physicians
and patients to understand that this
is a positive event because it means
there is likely to be a better
clinical outcome,” say authors of a
study conducted by OSI
Pharmaceuticals, Inc. The study,
published in Clinical Cancer Research,
a journal of the American Association
for Cancer Research, reports that for
patients taking erlotinib (brand name
Tarceva) who developed a moderate to
severe rash, survival without
progression of disease was 245 percent
longer than in patients who had a mild
rash or none at all.
In fact, in the majority of cases, the
more severe the rash, the longer a
patient’s cancer was held in check,
researchers found. “Some patients are
stopping treatment because of the
rash, yet those are the ones who are
most likely to benefit,” the said.
This is a critical problem and rather
than permanently discontinue
treatment, patients should talk to
their doctor about an effective and
proactive strategy to manage the rash
while continuing erlotinib therapy.
According to the researchers, these
rashes can be controlled with mild
steroids or antibiotics, and in most
cases, they will improve with
treatment. They are believed to be due
to an inflammatory response as a
result of EGFR inhibition in skin
tissue.
OSI Pharmaceuticals funded analysis
looked at two clinical trials testing
the drug in advanced non-small cell
lung cancer and pancreatic cancer. Of
the 673 patients in the lung cancer
study, and in the erlotinib-treated
group, 81 percent developed a rash,
the majority of which was grade 2.
The study graded rashes from 1,
relatively mild, to 4, severe. The
researchers found that the presence of
any rash correlated with overall and
progression-free survival and that
these correlations increased with the
grade of rash. Specifically, erlotinib-treated
patients who did not develop a rash
survived a median of 3.3 months,
compared to 7.1 months for those with
a grade 1 rash, and 11.1 months for
patients with more severe, grade 2
rashes.
They also found, however, that 18
percent of patients treated with a
placebo also developed a rash, and
that overall survival in these
patients was also significantly longer
(a median of 8.2 months compared to
4.7 months), compared to placebo
patients who didn’t develop a rash.
In the second clinical trial that
tested erlotinib and the chemotherapy
drug gemcitabine against a placebo
drug and gemcitabine in 521 patients
with advanced pancreatic cancer, 71
percent of patients using erlotinib /gemcitabine
developed a rash, compared with 30
percent of patients in the placebo
group.
Unlike the former study, these
pancreatic cancer patients with rashes
in the placebo group did not
experience an increase in survival
compared to placebo group patients
without a rash. In the Tarceva
treatment group, only a more severe
rash of grade 2 or higher was
associated with increased survival.
Patients with a grade 2 rash survived
a median of 10.8 months, compared to
treated patients with no rash (5.4
months) or a grade 1 rash (5.7
months).
However, the study points out that
lack of a rash doesn’t necessarily
mean that patients will not benefit
from the drug. “A small percentage of
patients who didn’t develop a rash
still had relatively long survival.
But, still, overall, patients who
don’t develop a rash don’t do as well
as those who do.”
This is not the first time that rash
has been associated with a survival
advantage with EGFR inhibitors – a
class of drugs which includes
erlotinib, cetuximab (Erbitux),
panitumumab (Vectibix) and others
designed to block overproduction of
the epidermal growth factor receptor –
but it is the most detailed analysis
to date.
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