Results of the non-small cell lung cancer part of a phase III, open-label, randomized trial evaluating topical corticosteroid therapy for facial acneiform dermatitis induced by EGFR inhibitors: stepwise rank down from potent corticosteroid (FAEISS study, NCCH-1512)

Purpose This FAEISS study was designed to confirm the superior efficacy of reactive topical corticosteroid strategies employing serially ranking-DOWN from very strong steroid levels for the treatment of facial acneiform rash induced by epidermal growth factor receptor (EGFR) inhibitors (EGFRIs), in comparison with strategies employing serially ranking-UP from weak steroid levels. This article reports the primary results of the non-small cell lung cancer (NSCLC) part of the trial. Methods Patients withEGFR-mutated advanced NSCLC treated with erlotinib or afatinib were enrolled in the first registration. All patients received preemptive therapy with oral minocycline and heparinoid moisturizer from the initiation of an EGFR inhibitor. Enrolled patients who developed facial acneiform rash within 2 weeks were randomized at second registration to either a ranking-UP (WEAK) group or a ranking-DOWN group. The primary endpoint was incidence of grade >= 2 facial acneiform rash over 8 weeks. Results Fifty-one patients were enrolled at the first registration and received EGFRIs (n= 30 for afatinib,n= 21 for erlotinib). However, 35 patients did not develop facial acneiform rash within 2 weeks; one patient discontinued preemptive treatment. Fifteen patients (29.4%) were enrolled in the second registration; nine were assigned to the WEAK group and six to the DOWN group. There was no significant difference in the incidence of grade >= 2 facial acneiform rash between the WEAK group (one patient, twice) and the DOWN group (one patient, twice;p= 0.8417). No patients developed severe facial acneiform rash within 10 weeks. Conclusion In NSCLC patients who received EGFRIs, preemptive therapy of oral minocycline and heparinoid moisturizer reduced facial acneiform rash incidence.

Automated summary

The study aimed to compare the efficacy of reactive topical corticosteroid strategies employing serially ranking-DOWN from very strong steroid levels with strategies employing serially ranking-UP from weak steroid levels in treating facial acneiform rash induced by EGFRIs. The results show that in NSCLC patients receiving EGFRIs, preemptive therapy of oral minocycline and heparinoid moisturizer can reduce the incidence of facial acneiform rash.