分子靶向抗肿瘤药物的皮肤不良反应及处理

分子靶向抗肿瘤药物分为胞膜相关药物、胞内相关药物和免疫调节剂3类。胞膜相关药物包括表皮生长因子受体抑制剂（EGFRIs）、KIT和BCR?ABL抑制剂、血管生成抑制剂和多靶点酪氨酸激酶抑制剂等。胞内相关药物包括RAS?RAF?MEK?ERK通路抑制剂、PI3K?AKT?mTOR通路抑制剂、Hedgehog信号通路抑制剂等。免疫调节剂包括细胞毒性T淋巴细胞抗原抑制剂和程序性死亡1受体抑制剂等。不同种类的药物引起的皮肤不良反应有共性，也有不同。多数皮肤不良反应呈剂量相关性、可逆性。治疗需根据皮疹的严重程度，轻者对症处理，重者则减量或停药。本文综述分子靶向抗肿瘤药物引起的皮肤不良反应及其防治对策。

Cutaneous adverse reactions to molecular targeted antitumor drugs and their management

Wang Fang, Tang Xuhua, Zhou Hui Department of Dermatology, First Affiliated Hospital, Sun Yat?sen University, Guangzhou 510080, China Corresponding author: Zhou Hui, Email: zhouhongcai@126.com 【Abstract】 There are three kinds of molecular targeted antitumor drugs: inhibitors of membrane?associated therapeutic targets, inhibitors of intracellular signaling pathways, and immunomodulators. Inhibitors of membrane?associated therapeutic targets include epidermal growth factor receptor inhibitors （EGFRIs）, KIT and BCR?ABL inhibitors, antiangiogenic agents and multikinase inhibitors. Inhibitors of intracellular signals include inhibitors of the RAS?RAF?MEK?ERK pathway, PI3K?AKT?mTOR pathway and Hedgehog signaling pathway. Inhibitors of cytotoxic T lymphocyte associated?antigen（CTLA） and programmed death 1 （PD?1） belong to immunomodulatory agents. Cutaneous adverse effects of different molecular targeted antitumor drugs share some common features, but also differ from each other. Most of the side effects are dose?dependent and reversible. Management strategies should be adjusted according to the severity of skin eruptions. Dose tapering and even discontinuation of antitumor drugs are necessary for very severe cases, but for mild ones, symptomatic treatment might be enough. This article reviews cutaneous adverse reactions to molecular targeted therapy as well as their prevention and management.