%0 Journal Article
%T Androgen Mediation〞and Antiandrogens Mitigation〞of the Epidermal Growth Factor Receptor (EGFR) Inhibitor每Induced Rash: Results From a Pilot Randomized Trial and Small Translational Case Series
%A Aminah Jatoi
%A Angelina Tan
%A Carmen Radecki Breitkopf
%A Christopher Dakhil
%A Donald Tindall
%A Jennifer G. Le-Rademacher
%A Kendrith Rowland
%A Lucy Schmidt
%A Mark Pittelkow
%A Pamela J. Atherton
%A Phuong L. Nguyen
%A Smitha Menon
%A Zhifu Sun
%J American Journal of Hospice and Palliative Medicineˋ
%@ 1938-2715
%D 2019
%R 10.1177/1049909118819820
%X Although 50% to 90% of patients who receive epidermal growth factor receptor (EGFR) inhibitors develop a rash, options for rash prevention or palliation remain limited. This issue is particularly important from a palliative care standpoint because these agents are prescribed only to patients with incurable cancer. Here, we report (1) gene expression profiling of skin biopsies from patients with an EGFR inhibitor每induced rash and (2) a randomized, placebo-controlled feasibility trial with the antiandrogen, spironolactone. Both investigations were undertaken to begin to explore the hypothesis that androgens mediate EGFR inhibitor每induced rash and that antiandrogens palliate it. First, 4 skin biopsies from patients with EGFR inhibitor每induced rash (3 men and 1 woman) were subject to gene expression microarray profiling. A public data set of normal skin gene expression (Gene Expression Omnibus, GSE22998) served as a reference. Sixty percent of commonly interrogated androgen receptor genes (207 of 308 between the 2 data sets) were differentially expressed (P < .05) in the rash samples. Second, in a 17-patient double-blinded, placebo-controlled trial with topical spironolactone applied to the face, although the primary feasibility end point was not achieved, patients in the spironolactone arm received more doses of EGFR inhibitor, and anecdotal photographic evidence suggested salutatory effects of spironolactone on rash. Epidermal growth factor receptor inhibitor每induced rash appears to be androgen-mediated; antiandrogen therapy merits further study for rash prevention/palliation
%K skin
%K rash
%K EGFR inhibitors
%K toxicity
%K palliative care
%K quality of life
%U https://journals.sagepub.com/doi/full/10.1177/1049909118819820