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EGFR Inhibitor Skin Rash — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyEGFR Inhibitor Skin RashSCE Medical Oncology

A 58-year-old woman on erlotinib for EGFR-mutant NSCLC develops a severe acneiform (papulopustular) rash affecting her face, scalp and upper trunk within 2 weeks of starting treatment. What does this skin toxicity predict about treatment efficacy?

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Correct answer: E — Acneiform rash severity with EGFR inhibitors correlates with treatment efficacy

Acneiform rash is the most common adverse effect of EGFR inhibitors (occurring in 50-80% of patients). Meta-analyses and individual trial data (BR.21, FLEX) consistently show that rash severity correlates with improved PFS and OS. This is because the rash reflects the degree of EGFR pathway inhibition in the skin (a pharmacodynamic biomarker). Management includes topical antibiotics (clindamycin), oral doxycycline (prophylactic or therapeutic), and emollients. Dose reduction should be avoided if the rash can be managed.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer