Management of symptoms and skin rash in patients with head and neck cancer treated with Cetuximab

Roxana-Andreea Rahnea-Niță (a), Gabriela Rahnea-Niță (b), C Macovei C (c), I Duluță (d), Aurora Ioniță (d), Anda-Natalia Ciuhu (e)

(a): MD, resident oncology, PhD student, Titan Psychiatric Hospital “Dr. Constantin Gorgos”, Department of Oncology, Bucharest, Romania
(b): MD, oncology, PhD, Chronic Disease Hospital “St. Luke “Department of Oncology – Palliative Care, Bucharest, Romania
(c): secretary, Chronic Disease Hospital “St. Luke “Department of Oncology – Palliative Care, Bucharest, Romania
(d): nurse, Chronic Disease Hospital “St. Luke “Department of Oncology – Palliative Care, Bucharest, Romania
(e): MD, oncology, PhD student, Chronic Disease Hospital “St. Luke “Department of Oncology – Palliative Care, Bucharest, Romania

Abstract

Background:
Head and neck cancer is the 6th most frequent cancer worldwide. The epidermal growth factor receptor (EGFR) is very often expressed in squamous cell carcinoma of the head and neck (oral cavity, oropharynx, nasopharynx, hypopharynx, and larynx).

Cetuximab is a monoclonal antibody, considered as the standard first line regimen in combination of a platinum-based chemotherapy, in recurrent and/or metastatic squamous cell carcinoma of the head and neck.

Material and method:
We evaluated 8 head and neck recurrent and/or metastatic cancer patients, treated with Cetuximab, in the year 2017, regarding management of pain, skin rash, general status, during 3 months after initiation of the treatment.

Results:
Three patients had no pain at the initiation of the treatment, while 4 patients presented moderate pain, and, after 3 months, 2 patients had no pain, while 3 patients presented moderate pain.

Four patients had a very good general status, and 2 patients presented moderate general status, at the initiation of the treatment, and, after 3 months, 3 patients continue to have a very good general status, while 1 patient has a moderate general status.

Skin rash appeared at all 8 patients, at 2 of them having grade 1, at 5 of them, grade 2, and, at 1 patient, grade 3.

Discussion:
Regarding pain management, after 3 months, 2 patients were treated with strong opioids (Oxycodone-80 mg/day) and adjuvants (Gabapentin 900mg/day), while 2 patients were treated with weak opioids (Codeine 90-120 mg/day) and adjuvants (Gabapentin 900 mg/day), and 1 patient was treated with Paracetamol.

All patients benefit of prevention and management of skin rash caused by Cetuximab with topical corticosteroids.

Conclusions:
Symptom management, communication, and attention to details are important parts of management of head and neck cancer patients who receive specific therapy. In this way, palliative care is integrated into medical oncology.

Key words: head and neck cancer, Cetuximab, skin rash

(Full text in Romanian language)

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