To summarize dermatologic toxicities associated with EGFR-pathway targeted therapies, particularly focusing on papulopustular eruptions and their management.
Approach:
Evidence Contexts: The review examines classical EGFR inhibitor-associated eruptions, MEK inhibitor-associated overlapping eruptions, and amivantamab-associated scalp-predominant disease.
Mechanistic Insights: Discusses mechanisms of inflammation and immune dysregulation, highlighting KLF4/IL-36γ signaling and Cutibacterium acnes involvement.
Management Strategies: Outlines evidence-aware management considerations, differentiating guideline-supported care from lower-level evidence for complex cases.
Key Findings:
Papulopustular eruptions are distinct from acne vulgaris and are common with classical EGFR inhibitors.
MEK inhibitors can cause overlapping dermatologic reactions due to their pharmacological relationship with EGFR pathways.
Amivantamab therapy is associated with complex scalp-predominant dermatologic presentations.
Interpretation:
The review provides an understanding of dermatologic reactions to EGFR-targeted therapies, highlighting the need for phenotype-specific management.
Limitations:
Some complex phenotypes are supported by retrospective studies and expert opinions rather than robust clinical trials.
Variability in patient responses and evolving treatment strategies complicate the establishment of standardized management protocols.
Conclusion:
The review emphasizes the importance of understanding the clinical spectrum of dermatologic reactions to optimize patient care in those undergoing EGFR-targeted therapies.
Analyses by treatment timing, cumulative dose, and stunting supported the overall finding, though early-initiation and female subgroup data were limited.
