Identification of immune-related mechanisms of cetuximab induced skin toxicity in colorectal cancer patients

PLoS One. 2022 Oct 21;17(10):e0276497. doi: 10.1371/journal.pone.0276497. eCollection 2022.

Abstract

Skin rash is a well-known predictive marker of the response to cetuximab (Cmab) in metastatic colorectal cancer (mCRC). However, the mechanism of skin rash development is not well understood. Following exposure to EGFR-targeted therapies, changes in IL-8 levels have been reported. The aim of this study was to evaluate the association between skin rash and inflammatory cytokine levels, including IL-8. Between 2014 and 2017, we prospectively enrolled 38 mCRC patients who underwent chemotherapy with either Cmab or bevacizumab (Bmab) at two hospitals. We performed multiplex cytokine ELISA with 20 inflammatory cytokines including E-selectin, GM-CSF, IFN-alpha, IFN-γ, IL-1 alpha, IL-1 beta, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-17A, IP-10, MCP-1, MIP-1 alpha, MIP-1 beta, P-selectin, sICAM-1, and TNF-alpha at baseline before cycle 1, 24 h after cycle 1, before cycle 2 (= 14 d), and before cycle 3 (= 28 d). Cytokine levels were compared using ANOVA after log-transformation. IL-8 genotypes in 30 patients treated with Cmab were determined using the polymerase chain reaction restriction fragment length polymorphism technique. Depending on the RAS mutational status, 30 and eight patients were treated with Cmab and Bmab-based chemotherapy, respectively. Skin rash developed in 23 (76.6%) of the 30 patients treated with Cmab plus FOLFIRI, after cycle 1. Only the mean log-transformed serum IL-8 level in patients with skin toxicity was statistically lower (2.83 ± 0.15) than in patients who did not experience skin toxicity (3.65 ± 0.27) and received Bmab (3.10 ± 0.26) (ANOVA test, p value = 0.0341). In addition, IL-8 polymorphism did not affect IL-8 levels, skin toxicity, or tumor response in Cmab treated patients. This study suggests that the inflammatory cytokine levels might be affected by Cmab exposure and are associated with the development of skin rash in mCRC patients. Further studies are warranted to evaluate this interaction in Cmab treated patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bevacizumab / therapeutic use
  • Cetuximab* / adverse effects
  • Chemokine CXCL10
  • Colorectal Neoplasms* / drug therapy
  • Colorectal Neoplasms* / genetics
  • Colorectal Neoplasms* / pathology
  • E-Selectin
  • ErbB Receptors / drug effects
  • ErbB Receptors / metabolism
  • Exanthema* / etiology
  • Exanthema* / immunology
  • Granulocyte-Macrophage Colony-Stimulating Factor / therapeutic use
  • Humans
  • Interleukin-10
  • Interleukin-13
  • Interleukin-17
  • Interleukin-1alpha
  • Interleukin-1beta
  • Interleukin-4
  • Interleukin-6
  • Interleukin-8
  • P-Selectin
  • Tumor Necrosis Factor-alpha / therapeutic use

Substances

  • Bevacizumab
  • Cetuximab
  • Chemokine CXCL10
  • E-Selectin
  • ErbB Receptors
  • Granulocyte-Macrophage Colony-Stimulating Factor
  • Interleukin-10
  • Interleukin-13
  • Interleukin-17
  • Interleukin-1alpha
  • Interleukin-1beta
  • Interleukin-4
  • Interleukin-6
  • Interleukin-8
  • P-Selectin
  • Tumor Necrosis Factor-alpha

Grants and funding

This study was supported by grant no. 0320150400 from the Seoul National University Hospital Research Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.