Erlotinib-Induced Skin Rash in Patients with Non-Small-Cell Lung Cancer: Pathogenesis, Clinical Significance, and Management

The human epidermal growth factor receptor (EGFR) signaling is overexpressed in many solid malignancies, making it an appealing target for biologic agents. A number of agents that target this receptor are in use or in development. A specific adverse effect common to this class of agents is an acneiform-like skin rash that has been related to EGFR inhibition in the skin. Little is known about the etiology of this rash, and there are no clear evidence-based management recommendations. Findings suggest that there is a relationship between the development of rash and response and/or survival, making rash a potential surrogate marker of activity. This review summarizes and updates the current knowledge of the clinical presentation, etiology, and predictive and prognostic value of erlotinib-induced skin rash and establishes a treatment strategy to help treat dermatologic adverse events and allow patients to continue therapy without dose interruption or drug discontinuation.