Prophylactic minocycline and reactive treatment are both acceptable options for the necessary treatment of erlotinib-induced rash in patients with metastatic non-small cell lung cancer (NSCLC) receiving second- or third-line treatment with erlotinib, a new study published online ahead of print in the Journal of Clinical Oncology has shown.1

Although erlotinib, an epidermal growth factor receptor (EGFR) inhibitor is effective in patients with advanced NSCLC who have a positive or unknown EGFR expression status, it can cause bothersome skin toxicity. Therefore, researchers sought to evaluate the effect of prophylactic treatment of erlotinib-induced skin rash.

For the prospective, phase 3 trial, researchers enrolled 150 patients receiving second- or third-line erlotinib for advanced NSCLC. Participants were randomly assigned 1:1:1 to receive prophylactic minocycline 100 mg twice daily for 4 weeks, reactive minocycline, or no treatment unless grade 3 rash developed.

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Results showed that skin toxicity occurred in 84% of patients regardless of treatment arm; however, prophylactic minocycline significantly prolonged the time to the most severe grade of rash. Researchers found that grade 3 rash was significantly higher in the no-treatment arm.

In regard to survival, overall survival was not significantly different between treatments, but patients receiving prophylactic or reactive minocycline had a 1.6 month and 2 month, respectively, longer overall survival= compared with those who received no rash treatment.

“The incidence of all grades of rash did not differ statistically among the three arms, so the trial was negative,” the authors conclude, but still recommend prophylactic or reactive minocycline as acceptable options for necessary treatment.


1. Melosky B, Anderson H, Burkes RL, et al. Pan Canadian Rash Trial: a randomized phase III trial evaluating the impact of a prophylactic skin treatment regimen on epidermal growth factor receptor-tyrosine kinase inhibitor–induced skin toxicities in patients with metastatic lung cancer [published online ahead of print November 16, 2015]. J Clin Oncol. doi:10.1200/JCO.2015.62.3918.