Papel das tetraciclinas orais na prevenção das erupções acneiformes em doentes de cancro do pulmão de não pequenas células sob terapêutica com inibidores da tirosina cinase do EGFR - Uma revisão sistemática

Abstract

Introduction: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are the current first line of treatment for non-small cell lung cancer (NSCLC). Acneiform rash is a common adverse effect of this treatment, leading to treatment interruption and affecting the patients' quality of life. Methods: A systematic review was conducted to assess the role of oral tetracyclines on the prevention of acneiform rash on NSCLC patients under treatment with EGFR TKIs. A search through Pubmed, Web of Science and Cochrane data bases was carried in January 2025. The studies were included if they tested for prophylactic treatment for acneiform rash with oral tetracyclines on NSCLC patients starting concomitantly the EGFR TKI. Results: From the eight selected studies, two found tetracyclines to reduce all-grade rash - doxycycline (74.2% to 57.2%) and tetracycline (75.6% to 44.5%, p=0.046). Three found tetracyclines did not reduce all-grade rash but were effective in reducing high-grade rash - doxycycline (19% to 4%, p<0.001), tetracycline (55% to 17%, p=0.009) and minocycline (28% to 12%, p=0.0455). Single-arm studies reported varying rash incidences with minocycline (from 44.8% to 68.3%), inferior to those found in the major trials used for comparison (67% and 77.7%). Conclusion: Oral tetracyclines seem to reduce the incidence of all- grade rash or, otherwise, reduce the incidence of high-grade rash. The option of preventive treatment for acneiform rash when commencing therapy with EGFR TKIs should be taken into consideration. Further controlled trials are required to confirm the efficacy of oral tetracyclines in the prevention of acneiform rash.