Review Article

Epidermal Growth Factor Receptor Inhibitors and Radiation Therapy in Head and Neck Cancer: Potential Management Strategies for Skin Reactions

Pamela Hallquist Viale, RN, MS, CS, ANP, AOCNP®, Marilyn L. Haas, PhD, ANP-C, and Mario E. Lacouture, MD

From Saratoga, California; Carolina Clinical Consultant, Asheville, North Carolina; and Memorial Sloan-Kettering Cancer Center, New York, New York.

Disclosures: Ms. Viale has served as a speaker for Bristol-Myers Squibb, Amgen Inc., Novartis AG, and Merck & Co., Inc., and as a consultant for Novartis AG and Meniscus Ltd. Dr. Haas has served as a consultant for Institute for Medical Education and Research, Inc. Dr. Lacouture has served as a consultant for Amgen Inc., Bristol-Myers Squibb, ImClone LLC., Eli Lilly and Company, Hana Biosciences, Bayer AG, Onyx, Boehringer Ingelheim GmbH, and Pfizer Inc.

Correspondence to: Pamela Hallquist Viale, RN, MS, CS, ANP, AOCNP®, 12721 Star Ridge Court, Saratoga, CA 95070-6510. E-mail: p.viale@comcast.net


J Adv Pract Oncol 2010;1:75–86 | DOI: 10.6004/jadpro.2010.1.2.10 | © 2010 Harborside Press


  

ABSTRACT

Head and neck cancer remains a formidable disease entity. Many of the patients with this tumor type present with locally advanced disease, and although treatment options have increased significantly, improving survival, patients with head and neck cancer often relapse or develop recurrent disease. Thus, interest in improving treatment of this patient population is significant. The mainstay of treatment has been radiation therapy. Recently, chemotherapy has been added to radiation to improve responsiveness. One of the most intriguing therapeutic options for this disease integrates the use of an epidermal growth factor receptor inhibiting (EGFRI) agent, cetuximab, with radiation therapy. In the pivotal trials studying this combination, radiation dermatitis was not significantly increased with the addition of this EGFRI agent. However, subsequent postmarketing reports and analyses have demonstrated different outcomes, with some patients experiencing enhanced skin toxicity with the combination of cetuximab and radiation therapy. This article will discuss the interaction of EGFRI therapy with radiation therapy in patients with head and neck cancer and current reports of increased skin toxicity. A case study format will illustrate patient outcomes and management strategies. Recommended guidelines for management of skin toxicity associated with radiation and EGFRI agents will be discussed.


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