Skin manifestations of gefitinib and the association with survival of advanced non-small-cell lung cancer in Taiwan

Background: Epidermal growth factor receptor antagonists, such as gefitinib, erlotinib, and cetuximab, have been used in treating carcinomas. The efficacies have been proposed to correlate with skin reactions, but the most important predictive indicator is still unknown. Our aim was to investigate the types of skin toxicities and to analyze the major therapeutic predictive indicators in Taiwan. Methods: A retrospective analysis was used to study 68 patients with advanced non-small-cell lung cancer receiving gefitinib. Results: Acneiform eruption (41.2%), xerosis (38.2%), pruritus (26.5%), and paronychia (16.2%) composed most of the skin reactions. The univariate analysis revealed paronychia as the most substantial survival predictive indicator (p=0.0427). In the multivariate analysis, older patients with paronychia had better prognosis (p=0.0050). Women tended to develop paronychia (p=0.1098). Xerosis positively correlated with paronychia (p=0.0082). Conclusion: Paronychia is the most indicative survival predictive factor among the skin manifestations, and it correlates with age, gender, and xerosis. Elucidation of the relationship between cutaneous reactions can provide information on the epidermal growth factor receptor signaling mechanism of skin