Epidermal Growth Factor Receptor Inhibitor-Associated Cutaneous Toxicities: Analysis Of Etiology,Pathogenesis And Treatments Based On Syndrome Differentiation In TCM

Purpose:To analyse etiology and pathogensis in TCM of drug eruption caused by EGFRIs,then evalute the efficafy of drug eruption and the interference of EGFRIs' anti-tumor efficafy,with Schizonepeta and Skin-Wash Lotion,in order to provide relevant theoretical and practical reference in the Chinese medicine Standardized therapy of drug eruption caused by EGFRIs.Methods:Using prospective and self-controlled research methods,collect a total of 28 cases which was divided into Wind-Heat Type,Stomach-Heat Type,Blood-Heat Type and Yin Deficiency Type,based on the theory of defensive Qi and Nutrient Blood.17 cases are in Chinese medicine group,may use the Chinese medicine therapy of Chizonepeta and Ledebouriella Four Agents Decoction and Skin-Wash Lotion,while 11 cases are in blank control group.Then formulat a standard of curative effect evaluation according to《Common Understanding》,contrast the changes of cutaneous toxicities grade in the two groups before and after treatment period,for the sake of evaluating the drug eruption efficafy of Chinese medicine.Besides,contrast patients' survival status and EGFRIs' anti-tumor efficafy after six month,with the Purpose to observe whether it would affect the EGFRIs' anti-tumor efficafy of Chinese medicine.Results:①In 28 cases,the most commom types of TCM syndrome is Wind-Heat Type(50%),then Stomach-Heat Type(28.57%),Blood-Heat Type(10.71%) and Yin Deficiency Type(10.71%).the most commom grades of cutaneous toxicities is "Moderate"(71.43%),then "Mild"(14.29%) and "Severe"(14.29%).②In 17 cases of Chinese medicine group,no one was cured,15 cases were improved(the improvement rate was 88.24%),2 cases were ineffective.Total effective rate was 88.24%.③In regard of the ditribution of the eruption,there is no change after treatment,but Rash density decreased,especially the impetigo reduced,in stead of some little red papule,skin erythema and desquamation.④In regard of the subjective symptoms of the eruption,The symptoms were markedly improved after Chinese medicine treatment,showing very significant difference(P＜0.01)⑤In regard of the types of TCM syndrome,we found that it shows significant difference in efficafy between Wind-Heat Type and Yin Deficiency Type,or between Stomach-Heat Type and Yin Deficiency Type(P＜0.05),but it shows no no significant difference in efficafy between Wind-Heat Type and Stomach-Heat Type(P＞0.05).⑥In regard of the grades of cutaneous toxicities,the improvment of the grade after treatment is very significant(P＜0.01),also it shows very significant between Chinese medicine group and blank control group(P＜0.01).⑦In regard of patients' survival status and EGFRIs' anti-tumor efficafy after six month,we found that all of 28 are survival,but none is evaluated as CR,In 17 cases of Chinese medicine group,1 case is PR,14 cases are SD,2 cases are PD,while 0 case is PR,9 cases are SD,2 case are PD in 11cases of blank control group,it showed no significant difference in EGFRIs' anti-tumor efficafy between Chinese medicine group and blank control group(P＞0.05).Conclusion:①The most commom grades of cutaneous toxicities is "Moderate",and the most commom types of TCM syndrome are Wind-Heat Type and Stomach-Heat Type.most of patients have those symptoms of "yin deficiency",such as painful gum,feverish feeling in palms and soles,dry mouth,reddened tongue with a little coating,deep thready pulse or rapid thready pulse,It may coinside the hypothesis that most patients has the physical condition of yin deficiency inner heat.②The TCM therapy in this study has definite therapeutic effect to drug eruption caused by EGFRIs:It can improve patients' subjective symptoms significantly,reduce drug eruption,especially the impetigo was reduced markedly.Compare with other types of TCM syndrome,Wind-Heat Type and Stomach-Heat Type have more significant efficafy to drug eruption.Furthermore, The TCM therapy had no significant influence to EGFRIs' anti-tumor efficafy. Altogether,it preliminary shows the advantages of Chinese medicine in reducing cutaneous toxicities caused by EGFRIs.