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The "Expert Consensus on the Clinical Management of Anti-EGFR Monoclonal Anti-EGFR Mab Treatment-Related Skin Adverse Reactions" (hereinafter referred to as the "Consensus") jointly formulated by the Colorectal Cancer Expert Committee of the Chinese Society of Clinical Oncology, the Dermatologist Branch of the Chinese Medical Doctor Association, and the Chinese Medical Education Association (hereinafter referred to as the "Consensus") "Journal of Practical Oncology" is officially released online and will be published in Volume 36, Issue 3, June 20211! (DOI:10.
13267/j.
cnki.
syzlzz.
2021.
042) The "Consensus" is the first collaboration between nearly 30 experts from the two universities of oncology and dermatology in China in the field of colorectal cancer, combining the clinical evidence-based experience of tumor treatment and skin management , After repeated discussions after multiple rounds of review meetings, it summarized the mechanism, diagnosis and grading standards and prevention measures of adverse skin reactions caused by anti-EGFR monoclonal antibody drug treatments that have been approved for marketing in China.
With a view to strengthening the awareness of oncology and dermatology medical workers to combat the adverse skin reactions of EGFR monoclonal antibodies, promote the standardization of clinical treatment and treatment, and maximize the survival gains of anti-EGFR monoclonal antibodies by improving the treatment compliance of patients with colorectal cancer Benefit, improve the quality of life of patients.
[In-depth interpretation by authoritative experts] Based on clinical services, patients with colorectal cancer can prolong their survival time, improve their quality of life, and benefit Chinese patients with colorectal cancer.
Professor Zhang Suzhan, director of the Cancer Center of the Second Affiliated Hospital of Zhejiang University School of Medicine.
Metastasis of anti-EGFR monoclonal antibodies in RAS/BRAF wild-type Colorectal cancer is widely used, and it is also used in other tumors.
Foreign clinical studies have shown that more than 80% of patients will have characteristic skin adverse reactions after using anti-EGFR monoclonal antibodies.
At the same time, in patients with colorectal cancer treated with anti-EGFR monoclonal antibodies, the incidence and severity of adverse skin reactions (especially papules and pustular rash) are closely related to the clinical efficacy of targeted tumor therapy and patient survival.
In this regard, Professor Zhang Suzhan of the Second Affiliated Hospital of Zhejiang University School of Medicine said: A large number of clinical studies have shown that the longer the course of anti-tumor treatment lasts, the longer the patient’s survival time will be.
However, in the process of tumor treatment, adverse drug reactions can also affect the patient's treatment compliance.
If at the beginning of treatment, improve the patient's understanding and anticipation of adverse skin reactions.
Even if there is a mild reaction, the patient can maintain the enthusiasm for treatment and cooperate with the oncologist's treatment, which will greatly help improve the patient's tolerance to the treatment.
At present, there are international consensus and guidelines for the skin adverse reactions of anti-EGFR monoclonal antibodies, but the field of colorectal cancer in China still lacks a unified understanding of the skin adverse reactions of anti-EGFR monoclonal antibodies.
This time, domestic experts in the two disciplines of oncology and dermatology worked together to formulate the first "Expert Consensus on Clinical Treatment of Adverse Skin Reactions Related to Anti-EGFR Monoclonal Antibody Treatment", filling the gap in this field in China.
From time to time, taking precautions against adverse skin reactions is a predictor of the efficacy of anti-EGFR monoclonal antibody treatment Anti-EGFR monoclonal antibodies (such as cetuximab) are currently widely used in the treatment of colorectal cancer at home and abroad, and their effectiveness and safety It has also been fully clinically verified.
Foreign clinical studies have shown that more than 80% of patients will have characteristic skin adverse reactions after using anti-EGFR monoclonal antibodies, such as papules pustular rash, paronychia, dry and itchy skin, abnormal hair and mucositis2.
According to a study of patients with advanced colorectal cancer in my country, the incidence of adverse skin reactions with anti-EGFR monoclonal antibodies is as high as 81.
4%.
Although most of the manifestations were mild, 17% of patients still had a dose reduction or even discontinuation of the drug due to adverse skin reactions.
At the same time, the incidence and severity of adverse skin reactions (especially papules and pustular rash) are positively correlated with the clinical efficacy and survival rate of targeted tumor therapy.
Colorectal cancer patients with papules and pustular rash after treatment have a longer survival time and a higher remission rate than those without rash, suggesting that papules and pustular rash is the clinical prognosis of cetuximab for colorectal cancer.
Indicator 3. Professor Yuan Ying, Chief Physician of the Department of Oncology, the Second Affiliated Hospital of Zhejiang University School of Medicine, said: “Adverse skin reactions of anti-EGFR monoclonal antibodies can appear as early as one week after treatment, and clinically often It takes 4-6 months of treatment to achieve the goal, and then enter maintenance treatment until the disease progresses.
There have been some subgroup analysis data of clinical studies that tell us that when patients receive anti-EGFR treatment and develop rashes, the effect is actually good Signals, we will encourage patients to use them.
Although the rash is not a life-threatening problem, the high incidence of 80% still brings great troubles to patients’ lives.
In foreign countries, doctors deal with rashes in a timely manner, mainly for the sake of Ensure the quality of life of patients.
The
"Consensus" starts from the needs of patients, refers to clinical evidence-based experience at home and abroad, combines the clinical experience of oncology and the professional depth of dermatology, and focuses on reducing the impact of adverse skin reactions on the quality of life of colorectal patients.
, I hope to help patients prolong the curative effect and ensure the quality of life.
"Strong combination, complement each other for the first time, to condense the wisdom of the Chinese Oncology and Dermatology Departments.
This "Consensus" is released by the Colorectal Cancer Expert Committee of the Chinese Society of Clinical Oncology, The Dermatologists Branch of the Chinese Medical Doctor Association organized nearly 30 experts from the two universities to realize interdisciplinary cooperation in the field of colorectal cancer for the first time.
The "Consensus" maximizes the benefits of treatment for patients and helps improve the quality of life of patients through four perspectives: improving cognition, promoting research, guiding clinical practice, and educating patients.
Professor Wang Gang, Dean of Xijing Dermatology Hospital of the Fourth Military Medical University, said: “Drug-induced skin rash is the most common adverse reaction of anti-EGFR monoclonal antibodies.
Nursing interventions that not only cause pain to patients, but also cause discontinuation of the drug and worsen the condition.
The core meaning of the "Consensus" is to solve the adverse reactions of anti-EGFR monoclonal antibodies, we need to focus on skin inflammation control and skin barrier Rehabilitation is for doctors and patients to achieve correct education, effective prevention, early diagnosis and timely treatment of adverse skin reactions.
First of all, the "Consensus" will improve our understanding of adverse skin reactions induced by anti-EGFR monoclonal antibodies, so that doctors in the field of oncology and skin will be more familiar with this problem, and its diagnosis, classification, classification and treatment will be clarified.
Secondly, experts in the skin field have in-depth thinking about the causes and mechanisms of skin reactions induced by anti-EGFR monoclonal antibodies.
The launch of the "Consensus" will greatly promote research in this field.
If the mechanism of adverse skin reactions is understood from the mechanism level, It is very helpful for efficient and accurate treatment in the future.
Third, the "Consensus" is of great clinical significance, helping clinical experts in the field of oncology and dermatology to have a clearer understanding of how to judge skin reactions after they occur, and how to treat them with different severity levels.
Fourth, the "Consensus" will also help patients better understand the objectivity of skin reactions, help patients correctly understand skin adverse reactions, and achieve'early prevention and early intervention'.
"Clear the plan, based on China's skin reaction "early prevention, early intervention" to ensure the treatment compliance of patients with colorectal cancer.
After repeated discussions by oncology and dermatology experts, the "Consensus" aims at the occurrence of adverse skin reactions of clinical anti-EGFR monoclonal antibodies in China.
Characteristics, it is recommended to select oral and topical drugs that are widely used in the country and are also available in primary hospitals, which makes the prevention and clinical treatment of adverse drug reactions feasible.
Professor Xiang Leihong, director of the Department of Dermatology, Huashan Hospital, Fudan University Physician Professor Xiang Leihong, chief physician of the Department of Dermatology, Huashan Hospital Affiliated to Fudan University, said: “With the increasing use of targeted tumor drugs, dermatology departments continue to encounter patients with adverse skin reactions caused by targeted drugs, such as colorectal cancer.
The treatment of adverse skin reactions of patients with anti-EGFR monoclonal antibodies is a very good opportunity for multidisciplinary collaboration.
By cooperating with oncologists, we can formulate this consensus from different angles and provide very helpful guidance for clinical treatment.
For patients, education is also very important.
Before the patient has a skin adverse reaction, he can start to take preventive measures in a targeted manner.
Know in advance the possible time and severity of the skin adverse reaction, as well as what measures the patient needs to take.
To a large extent, it helps patients to reduce the occurrence of adverse skin reactions, or to keep the adverse reactions at an early stage, so as to finally realize the full benefit of patients. In terms of multidisciplinary cooperation, patient screening and education are carried out before treatment, a dermatology referral and consultation model is established during treatment, and a personalized treatment plan is developed through multidisciplinary collaboration with dermatology when serious adverse reactions occur.
Greatly help patients with colorectal cancer complete the full course of treatment.
"Pull the cloud to see the day, and look forward to the future.
From now on, we will start the whole process of colorectal cancer management.
A new future.
Colorectal cancer is the third most common malignant tumor in China.
The development of precision medicine brings more hope to patients.
Cetuximab is useful for colorectal treatment.
Efficacy and safety have been extensively verified in clinical practice.
Compared with chemotherapy alone, chemotherapy plus cetuximab can have a survival of nearly 40 months for patients with RAS WT left half mCRC, and the addition of anti-EGFR monoclonal antibody can significantly prolong patients Survival time.
With the gradual development of clinical precision treatment, through the establishment of a complete full-process management of colorectal cancer, pay close attention to the survival and quality of life of patients, and maximize the benefits of treatment for patients.
In this context, the first edition of " The "Consensus" condenses the high-level clinical treatment wisdom of the Chinese Oncology and Dermatology Departments at this stage, and will help improve the clinical practice of preventing and handling adverse skin reactions related to anti-EGFR monoclonal antibody treatment, and improve clinical oncologists in China The cognition and practical ability of anti-EGFR monoclonal antibody treatment of skin adverse reaction management opened a new direction for the clinical evidence-based treatment of colorectal cancer in the two universities, and ultimately benefited colorectal cancer patients throughout China.
[Exciting content first look] "Consensus" discusses and summarizes the occurrence, diagnosis and grading standards and prevention measures of skin adverse reactions caused by anti-EGFR monoclonal antibody treatments that have been approved for marketing in China, including 6 core contents: anti-EGFR The mechanism of skin adverse reactions related to monoclonal antibody treatment The clinical manifestations and severity of skin adverse reactions related to anti-EGFR monoclonal antibody treatment The impact of skin adverse reactions related to anti-EGFR monoclonal antibody treatment on the quality of life of patients Anti-EGFR monoclonal antibody treatment related Treatment of adverse skin reactions Anti-EGFR monoclonal antibody treatment-related skin adverse reactions Prevention of skin adverse reactions related to anti-EGFR monoclonal antibody Multidisciplinary cooperation [Highlights] Patient priority, subject complementarity "Consensus" starts from the needs of patients and combines clinical oncology Experience and professional depth of dermatology focus on reducing the impact of skin reactions on the quality of life of patients.
It is hoped that patients will be informed about treatment and ultimately prolong patient survival.
Accurately grading, clarifying the symptomatic reactions to different levels of skin, focusing on drugs with proven ingredients and effects across the country, and formulating a clear administration plan for external drugs and systemic drugs to meet the needs of clinical practice in China.
Correct education and prevention.
Preventive measures before the start of the first treatment are of great significance to patients’ lives and the quality of treatment.
For this reason, the "Consensus" formulates "primary prevention" for all patients and "secondary prevention" for high-risk patients.
. References: 1.
Expert consensus on clinical management of skin adverse reactions associated with anti-EGFR monoclonal antibody therapy.
Journal of Practical Oncology.
2021;36(3):195-2012.
Agero AL, et al.
Dermatologic side effects associated with the epidermal growth factor receptor inhibitors.
Journal of the American Academy of Dermatology.
2006;55(4):657–6703.
Chiang TY, et al.
EGFRI-associated health-related quality of life by severity of skin toxicity in metastatic colorectal cancer patients receiving epidermal growth factor receptor inhibitor target therapy.
Supportive Care in Cancer.
28(10):4771–4779
13267/j.
cnki.
syzlzz.
2021.
042) The "Consensus" is the first collaboration between nearly 30 experts from the two universities of oncology and dermatology in China in the field of colorectal cancer, combining the clinical evidence-based experience of tumor treatment and skin management , After repeated discussions after multiple rounds of review meetings, it summarized the mechanism, diagnosis and grading standards and prevention measures of adverse skin reactions caused by anti-EGFR monoclonal antibody drug treatments that have been approved for marketing in China.
With a view to strengthening the awareness of oncology and dermatology medical workers to combat the adverse skin reactions of EGFR monoclonal antibodies, promote the standardization of clinical treatment and treatment, and maximize the survival gains of anti-EGFR monoclonal antibodies by improving the treatment compliance of patients with colorectal cancer Benefit, improve the quality of life of patients.
[In-depth interpretation by authoritative experts] Based on clinical services, patients with colorectal cancer can prolong their survival time, improve their quality of life, and benefit Chinese patients with colorectal cancer.
Professor Zhang Suzhan, director of the Cancer Center of the Second Affiliated Hospital of Zhejiang University School of Medicine.
Metastasis of anti-EGFR monoclonal antibodies in RAS/BRAF wild-type Colorectal cancer is widely used, and it is also used in other tumors.
Foreign clinical studies have shown that more than 80% of patients will have characteristic skin adverse reactions after using anti-EGFR monoclonal antibodies.
At the same time, in patients with colorectal cancer treated with anti-EGFR monoclonal antibodies, the incidence and severity of adverse skin reactions (especially papules and pustular rash) are closely related to the clinical efficacy of targeted tumor therapy and patient survival.
In this regard, Professor Zhang Suzhan of the Second Affiliated Hospital of Zhejiang University School of Medicine said: A large number of clinical studies have shown that the longer the course of anti-tumor treatment lasts, the longer the patient’s survival time will be.
However, in the process of tumor treatment, adverse drug reactions can also affect the patient's treatment compliance.
If at the beginning of treatment, improve the patient's understanding and anticipation of adverse skin reactions.
Even if there is a mild reaction, the patient can maintain the enthusiasm for treatment and cooperate with the oncologist's treatment, which will greatly help improve the patient's tolerance to the treatment.
At present, there are international consensus and guidelines for the skin adverse reactions of anti-EGFR monoclonal antibodies, but the field of colorectal cancer in China still lacks a unified understanding of the skin adverse reactions of anti-EGFR monoclonal antibodies.
This time, domestic experts in the two disciplines of oncology and dermatology worked together to formulate the first "Expert Consensus on Clinical Treatment of Adverse Skin Reactions Related to Anti-EGFR Monoclonal Antibody Treatment", filling the gap in this field in China.
From time to time, taking precautions against adverse skin reactions is a predictor of the efficacy of anti-EGFR monoclonal antibody treatment Anti-EGFR monoclonal antibodies (such as cetuximab) are currently widely used in the treatment of colorectal cancer at home and abroad, and their effectiveness and safety It has also been fully clinically verified.
Foreign clinical studies have shown that more than 80% of patients will have characteristic skin adverse reactions after using anti-EGFR monoclonal antibodies, such as papules pustular rash, paronychia, dry and itchy skin, abnormal hair and mucositis2.
According to a study of patients with advanced colorectal cancer in my country, the incidence of adverse skin reactions with anti-EGFR monoclonal antibodies is as high as 81.
4%.
Although most of the manifestations were mild, 17% of patients still had a dose reduction or even discontinuation of the drug due to adverse skin reactions.
At the same time, the incidence and severity of adverse skin reactions (especially papules and pustular rash) are positively correlated with the clinical efficacy and survival rate of targeted tumor therapy.
Colorectal cancer patients with papules and pustular rash after treatment have a longer survival time and a higher remission rate than those without rash, suggesting that papules and pustular rash is the clinical prognosis of cetuximab for colorectal cancer.
Indicator 3. Professor Yuan Ying, Chief Physician of the Department of Oncology, the Second Affiliated Hospital of Zhejiang University School of Medicine, said: “Adverse skin reactions of anti-EGFR monoclonal antibodies can appear as early as one week after treatment, and clinically often It takes 4-6 months of treatment to achieve the goal, and then enter maintenance treatment until the disease progresses.
There have been some subgroup analysis data of clinical studies that tell us that when patients receive anti-EGFR treatment and develop rashes, the effect is actually good Signals, we will encourage patients to use them.
Although the rash is not a life-threatening problem, the high incidence of 80% still brings great troubles to patients’ lives.
In foreign countries, doctors deal with rashes in a timely manner, mainly for the sake of Ensure the quality of life of patients.
The
"Consensus" starts from the needs of patients, refers to clinical evidence-based experience at home and abroad, combines the clinical experience of oncology and the professional depth of dermatology, and focuses on reducing the impact of adverse skin reactions on the quality of life of colorectal patients.
, I hope to help patients prolong the curative effect and ensure the quality of life.
"Strong combination, complement each other for the first time, to condense the wisdom of the Chinese Oncology and Dermatology Departments.
This "Consensus" is released by the Colorectal Cancer Expert Committee of the Chinese Society of Clinical Oncology, The Dermatologists Branch of the Chinese Medical Doctor Association organized nearly 30 experts from the two universities to realize interdisciplinary cooperation in the field of colorectal cancer for the first time.
The "Consensus" maximizes the benefits of treatment for patients and helps improve the quality of life of patients through four perspectives: improving cognition, promoting research, guiding clinical practice, and educating patients.
Professor Wang Gang, Dean of Xijing Dermatology Hospital of the Fourth Military Medical University, said: “Drug-induced skin rash is the most common adverse reaction of anti-EGFR monoclonal antibodies.
Nursing interventions that not only cause pain to patients, but also cause discontinuation of the drug and worsen the condition.
The core meaning of the "Consensus" is to solve the adverse reactions of anti-EGFR monoclonal antibodies, we need to focus on skin inflammation control and skin barrier Rehabilitation is for doctors and patients to achieve correct education, effective prevention, early diagnosis and timely treatment of adverse skin reactions.
First of all, the "Consensus" will improve our understanding of adverse skin reactions induced by anti-EGFR monoclonal antibodies, so that doctors in the field of oncology and skin will be more familiar with this problem, and its diagnosis, classification, classification and treatment will be clarified.
Secondly, experts in the skin field have in-depth thinking about the causes and mechanisms of skin reactions induced by anti-EGFR monoclonal antibodies.
The launch of the "Consensus" will greatly promote research in this field.
If the mechanism of adverse skin reactions is understood from the mechanism level, It is very helpful for efficient and accurate treatment in the future.
Third, the "Consensus" is of great clinical significance, helping clinical experts in the field of oncology and dermatology to have a clearer understanding of how to judge skin reactions after they occur, and how to treat them with different severity levels.
Fourth, the "Consensus" will also help patients better understand the objectivity of skin reactions, help patients correctly understand skin adverse reactions, and achieve'early prevention and early intervention'.
"Clear the plan, based on China's skin reaction "early prevention, early intervention" to ensure the treatment compliance of patients with colorectal cancer.
After repeated discussions by oncology and dermatology experts, the "Consensus" aims at the occurrence of adverse skin reactions of clinical anti-EGFR monoclonal antibodies in China.
Characteristics, it is recommended to select oral and topical drugs that are widely used in the country and are also available in primary hospitals, which makes the prevention and clinical treatment of adverse drug reactions feasible.
Professor Xiang Leihong, director of the Department of Dermatology, Huashan Hospital, Fudan University Physician Professor Xiang Leihong, chief physician of the Department of Dermatology, Huashan Hospital Affiliated to Fudan University, said: “With the increasing use of targeted tumor drugs, dermatology departments continue to encounter patients with adverse skin reactions caused by targeted drugs, such as colorectal cancer.
The treatment of adverse skin reactions of patients with anti-EGFR monoclonal antibodies is a very good opportunity for multidisciplinary collaboration.
By cooperating with oncologists, we can formulate this consensus from different angles and provide very helpful guidance for clinical treatment.
For patients, education is also very important.
Before the patient has a skin adverse reaction, he can start to take preventive measures in a targeted manner.
Know in advance the possible time and severity of the skin adverse reaction, as well as what measures the patient needs to take.
To a large extent, it helps patients to reduce the occurrence of adverse skin reactions, or to keep the adverse reactions at an early stage, so as to finally realize the full benefit of patients. In terms of multidisciplinary cooperation, patient screening and education are carried out before treatment, a dermatology referral and consultation model is established during treatment, and a personalized treatment plan is developed through multidisciplinary collaboration with dermatology when serious adverse reactions occur.
Greatly help patients with colorectal cancer complete the full course of treatment.
"Pull the cloud to see the day, and look forward to the future.
From now on, we will start the whole process of colorectal cancer management.
A new future.
Colorectal cancer is the third most common malignant tumor in China.
The development of precision medicine brings more hope to patients.
Cetuximab is useful for colorectal treatment.
Efficacy and safety have been extensively verified in clinical practice.
Compared with chemotherapy alone, chemotherapy plus cetuximab can have a survival of nearly 40 months for patients with RAS WT left half mCRC, and the addition of anti-EGFR monoclonal antibody can significantly prolong patients Survival time.
With the gradual development of clinical precision treatment, through the establishment of a complete full-process management of colorectal cancer, pay close attention to the survival and quality of life of patients, and maximize the benefits of treatment for patients.
In this context, the first edition of " The "Consensus" condenses the high-level clinical treatment wisdom of the Chinese Oncology and Dermatology Departments at this stage, and will help improve the clinical practice of preventing and handling adverse skin reactions related to anti-EGFR monoclonal antibody treatment, and improve clinical oncologists in China The cognition and practical ability of anti-EGFR monoclonal antibody treatment of skin adverse reaction management opened a new direction for the clinical evidence-based treatment of colorectal cancer in the two universities, and ultimately benefited colorectal cancer patients throughout China.
[Exciting content first look] "Consensus" discusses and summarizes the occurrence, diagnosis and grading standards and prevention measures of skin adverse reactions caused by anti-EGFR monoclonal antibody treatments that have been approved for marketing in China, including 6 core contents: anti-EGFR The mechanism of skin adverse reactions related to monoclonal antibody treatment The clinical manifestations and severity of skin adverse reactions related to anti-EGFR monoclonal antibody treatment The impact of skin adverse reactions related to anti-EGFR monoclonal antibody treatment on the quality of life of patients Anti-EGFR monoclonal antibody treatment related Treatment of adverse skin reactions Anti-EGFR monoclonal antibody treatment-related skin adverse reactions Prevention of skin adverse reactions related to anti-EGFR monoclonal antibody Multidisciplinary cooperation [Highlights] Patient priority, subject complementarity "Consensus" starts from the needs of patients and combines clinical oncology Experience and professional depth of dermatology focus on reducing the impact of skin reactions on the quality of life of patients.
It is hoped that patients will be informed about treatment and ultimately prolong patient survival.
Accurately grading, clarifying the symptomatic reactions to different levels of skin, focusing on drugs with proven ingredients and effects across the country, and formulating a clear administration plan for external drugs and systemic drugs to meet the needs of clinical practice in China.
Correct education and prevention.
Preventive measures before the start of the first treatment are of great significance to patients’ lives and the quality of treatment.
For this reason, the "Consensus" formulates "primary prevention" for all patients and "secondary prevention" for high-risk patients.
. References: 1.
Expert consensus on clinical management of skin adverse reactions associated with anti-EGFR monoclonal antibody therapy.
Journal of Practical Oncology.
2021;36(3):195-2012.
Agero AL, et al.
Dermatologic side effects associated with the epidermal growth factor receptor inhibitors.
Journal of the American Academy of Dermatology.
2006;55(4):657–6703.
Chiang TY, et al.
EGFRI-associated health-related quality of life by severity of skin toxicity in metastatic colorectal cancer patients receiving epidermal growth factor receptor inhibitor target therapy.
Supportive Care in Cancer.
28(10):4771–4779
