Pulsed Azithromycin for the Treatment of Dacomitinib Induced Skin Toxicity in Patient with Tetracycline Intolerance - A Case Report.

Skin toxicities like paronychia and acneiform rash are common side effects of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKI) and significantly impact patients' quality of life. Tetracycline antibiotics are the recommended first-line treatment but can cause side effects, leading to intolerance and untreated toxicities, highlighting needs for alternative therapies. We present a case of stage IV EGFR-mutated non-small cell lung cancer (NSCLC) treated with the second-generation EGFR TKI, dacomitinib. The patient developed grade 3 skin toxicities and was subsequently treated with azithromycin after demonstrating intolerance to tetracycline antibiotics. Azithromycin was administered using various dosing strategies, and we found 500 mg every other day might be the most effective regimen for treating EGFR-TKI-induced acneiform rash. However, this approach appeared to be less effective in managing paronychia.