Skin reactions to the new biologic anticancer drugs

PURPOSE OF REVIEW: To review the clinical presentation and management of cutaneous side effects of some of the new targeted anticancer therapies.

RECENT FINDINGS: Advances in molecular biology have led to the development of pharmacologic agents that specifically target crucial molecules on malignant cells, or their surrounding cellular milieu (e.g. angiogenesis inhibitors), or both. Successful treatments for several solid tumors, including colorectal carcinoma, nonsmall cell lung cancer, head and neck cancer and renal cell carcinoma, have recently been implemented as a result of these advances. Although these agents are generally much better tolerated than their cytotoxic predecessors, new groups of side effects have emerged, especially with regard to the skin. Multikinase inhibitors, monoclonal antibodies, and - in particular - antiepidermal growth factor inhibitors are associated with cutaneous reactions that may not only be dose limiting, but may significantly affect quality of life. The spectrum of these reactions ranges from disfiguring acneiform facial eruptions, to impaired wound healing, to disabling hand-foot syndromes, which can seriously impair mobility.

SUMMARY: The recognition, prevention and management of the cutaneous side effects of these targeted agents can allow successful continuation of antineoplastic therapy, and minimize patient distress.