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Anti-EGFR Rash Management — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyAnti-EGFR Rash ManagementSCE Medical Oncology

A 60-year-old man with metastatic colon cancer on FOLFOX + panitumumab develops an extensive acneiform rash (grade 3, >30% BSA, limiting self-care). What management reduces severity while preserving therapeutic efficacy?

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Correct answer: D — Dose reduction of panitumumab by 50% with reactive skin management (oral doxycycline, topical corticosteroids, emollients) — the rash is a pharmacodynamic biomarker and dose reduction should be minimised

Grade 3 acneiform rash from anti-EGFR therapy requires treatment interruption until improvement to ≤grade 2, then dose reduction. Prophylactic skin management (oral doxycycline 100 mg BD, moisturisers, sunscreen — the STEPP trial protocol) reduces severity. The correlation between rash severity and treatment efficacy creates a clinical tension: aggressive rash management preserves quality of life while maintaining drug dosing. Complete panitumumab cessation should be avoided if possible given the rash-efficacy correlation.

Reference: ESMO 2024 mCRC and Dermatological Toxicity; BNF Panitumumab; STEPP trial Lacouture et al JCO 2010