RESUMEN
INTRODUCTION: Inhibition of the EGFR has emerged as a promising anticancer strategy, offering improved efficacy and quality of life for patients affected by tumors. The overall level of toxicity associated with EGFR inhibitors is low compared to other chemotherapy drugs, although they are commonly associated with skin and gastrointestinal adverse events. Thus, patients' quality of life may be considerably affected both by a physical and a psychosocial perspective. Adverse events that lead to treatment interruption or cessation may significantly compromise their outcome. AREAS COVERED: This review summarizes the characteristics of the distinctive toxicities of drugs targeting EGFR, addressing their incidence, pathophysiology and clinical presentation with a focus on the management of skin rash and other relevant adverse events, according to the available clinical evidence. Data regarding the correlation between the development of skin rash and clinical outcome are also reported. EXPERT OPINION: Drugs targeting EGFR are associated with a lower overall incidence of systemic side effects compared to standard chemotherapeutic agents; nevertheless, an increased risk of distinct toxicities that may affect patient's quality of life and anticancer treatment compliance is observed. Thus, clinical training projects directed toward a more accurate knowledge of such adverse events are essential to maximize the progress of targeted therapies against cancer.
Asunto(s)
Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Receptores ErbB/antagonistas & inhibidores , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Erupciones por Medicamentos/epidemiología , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
BACKGROUND: Respiratory intensive care units (RICU) dedicated to weaning could be suitable facilities for clinical management of "post-ICU" patients. METHODS: We retrospectively analyzed the time course of patients' characteristics, clinical outcomes and medical staff utilization in five Italian RICUs by comparing three periods of 5 consecutive years (from 1991 to 2005). RESULTS: A total of 3,106 patients (age 76 +/- 4 years; 72% males) were analyzed. The number of co-morbidities per patient (from 1.8 to 3.0, p = 0.05) and the previous intensive care unit (ICU) stay (from 25 to 32 days, p = 0.002) increased over time. The doctor-to-patient ratio significantly decreased over time (from 1:3 to 1:5, p < 0.01), whereas the physiotherapist-to-patient ratio mildly increased (from 1:6 to 1:4.5, p < 0.05). The overall weaning success rate decreased (from 87 to 66%, p < 0.001), and the discharge destination changed (p < 0.001) over time; fewer patients were discharged to home (from 22 to 10%), and more patients to nursing home (from 3 to 6%), acute hospitals (from 6 to 10%) and rehabilitative units (from 70 to 75%). The mortality rate increased over time (from 9 to 15%). Significant correlations between the doctor-to-patient ratio and the rates of weaning success (r = 0.679, p = 0.005), home discharge (r = 0.722, p = 0.002) and the RICU length of stay (LOS) (r = -0.683, p = 0.005) were observed. CONCLUSIONS: The clinical outcomes of our units worsened over 15 years, likely as consequence of admitting more severely ill patients. The potential further negative influence of reduced medical staff availability on weaning success, home discharge and LOS warrants future prospective investigations.