Congress Abstracts 2006

153

MANAGING CUTANEOUS SIDE EFFECTS ASSOCIATED WITH ERLOTINIB IN HEAD AND NECK CANCER (HNC)/NON-SMALL CELL LUNG CANCER (NSCLC) PATIENTS: NURSING ROLE. Karen Oishi, ANP-C, GNP-C, APRN, MSN, OCN^®, and Edward Kim, MD, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Erlotinib (Tarceva) is an oral epidermal growth factor receptor (EGFR) targeted therapy. It is approved for therapy in NSCLC patients after failure of at least one prior chemotherapy regimen. It has also been studied in other tumors including HNC. Erlotinib has fewer side effects compared to standard chemotherapy. Cutaneous toxicities with erlotinib have been observed in approximately seventy percent of patients with most cases typically mild-to-moderate. The most common manifestations are rash, pruritus, and dryness. Oncology nurses encounter these patients often in clinics. As rash may be a marker of clinical benefit and response, continuing therapy through toxicities is important.

We seek to describe effective interventions for management of cutaneous toxicities associated with erlotinib. Nurses are an important component of the treating team, and need to understand how to assess and manage these toxicities to avoid unnecessary treatment discontinuation. Currently, there are no standard treatment strategies for EGFR associated rashes.

We have developed a treatment algorithm for EGFR-related cutaneous toxicities and applied it prospectively to patients treated with erlotinib in a HNC clinical trial as well as NSCLC patients seen in clinic. Fifty-five patients have been evaluated thus far.

A phase II HNC trial has enrolled 32 patients and 28 are evaluable for toxicity. Nineteen patients developed grade 1 rash, 8 patients grade 2, 1 patient grade 3, and no grade 4. Response to rash intervention (i.e. downgrading the rash) included 19/19 complete responses for grade 1, 6/8 partial responses for grade 2 and 1/1 partial response for grade 3 were noted. Three patients experienced dose delay and/or dose modification. In addition, 33 NSCLC patients are also evaluable for toxicity. Twenty five patients developed grade 1 rash, 4 patients grade 2, 4 patients grade 3, and none grade 4. Response to rash intervention included 25/25 complete responses for grade 1, 4/4 complete/partial responses for grade 2 and 3. Four patients experienced dose delays and/or dose modifications.

Successful management of cutaneous toxicities associated with erlotinib is achievable using the proposed algorithm. Furthermore, this will assist the nurses to practice evidence-based nursing care for patients receiving erlotinib.