Table 4.

BCCA management guidelines for EGFR–TKI induced rash.

Grade	Toxicity	EGFR inhibitor
1	Macular or papular eruption or erythema with no associated symptoms	Maintain dose level of TKI Consider clindamycin 2% and hydrocortisone 1% in a lotion to be applied topically BID as needed
2	Macular or papulopustular eruption or erythema with pruritus or other symptoms that are tolerable or interfere with daily life	Maintain dose level of TKI Consider clindamycin 2% and hydrocortisone 1% in a lotion to be applied topically BID as needed +minocycline 100 mg PO BID for 1–2 weeks or longer as needed
3	Severe, generalized erythroderma, or macular, popular or vesicular eruption	Withhold EGFR TKI for 10–14 days When improvement to grade 2 or less, continue at 50% of original dose If toxicities do not worsen, escalate by 25% increments of original dose until starting dose is reached If no improvement, discontinue Continue treatment with clindamycin 2% and hydrocortisone 1% in a lotion to be applied topically BID as needed +minocycline 100 mg PO BID for 1 to 2 weeks or longer as needed
4	Generalized exfoliative, ulcerative, or blistering skin toxicity	Discontinue treatment

Adapted from the management guidelines utilized in the BC Cancer Agency (BCCA) Oncology Department.