Abstract
Introduction
Tyrosine kinase inhibitors (TKIs), although considered less toxic than conventional
chemotherapy, are not short of adverse drug reactions (ADRs). Cutaneous toxicities
are among the most frequently reported ADRs; when severe, they can cause substantial
morbidity, often requiring dose reduction or drug cessation.
Objectives
1. To estimate the frequency and pattern of mucocutaneous adverse reactions of TKI.
2. To grade the adverse reactions based on the severity scale of CTCAE v 5.0.
Materials and Methods
This was a hospital-based observational study of 105 patients on TKI chemotherapy,
attending the outpatient departments of dermatology and medical oncology, at Justice
K.S. Hegde Charitable Hospital, Mangalore, from October 1, 2022, to April 30, 2024.
Mucocutaneous adverse reactions after the initiation of TKI were recorded and graded
according to the severity scale of CTCAE v 5.0. and causality was assessed using WHO-UMC
criteria.
Results
Among 105 patients, a majority of 34 (32.4%) patients belonged to the age group of
51 to 60 years, with a male predominance of 2:1. The most frequent cancer was lung
in 38 (36.2%) patients, followed by CML in 21 (20.0%) patients. The most common class
of TKI agent used was EGFR inhibitors in 51 (48.6%) patients, with gefitinib being
the most common TKI agent in 46 (43.8%) patients. The most frequently reported ADRs
were xerosis in 45 (42.9%) patients, followed by eczematous changes in 37 (35.2%)
patients. The papulopustular rash was most commonly seen with EGFR inhibitors in 25
(49.0%) patients, eczematous changes with BCR–ABL inhibitors in 14 (50.0%), and hand–foot skin reaction with multikinase inhibitors
in 12 (54.4%) patients. A statistically significant association was noted between
papulopustular rash and paronychia among patients on EGFR inhibitors. Additionally,
a statistically significant association was noted between hand–foot skin reaction
and subsequent dose reduction.
Conclusion
An awareness regarding the various ADRs of TKIs and interdisciplinary cooperation
between oncologists and dermatologists will help in precise diagnosis and early identification
of various cutaneous toxicities.
Keywords
adverse drug reactions - tyrosine kinase inhibitors - EGFR inhibitors - targeted chemotherapy
