Dr McLellan on the Association Between A Skin Bacterium and Severe Acute Radiation Dermatitis

Beth N. McLellan, MD, director, supportive oncodermatology, Montefiore Einstein Comprehensive Cancer Center, chief, Division of Dermatology, Montefiore Health System, Albert Einstein College of Medicine discusses the use of a low-cost, topical treatment to prevent severe cases of acute radiation dermatitis (ARD) potentially caused by the skin bacterium Staphylococcus aureus (SA).

According to 2 studies concurrently published in JAMA Oncology, ARD may be associated with SA bacteria, and could be effectively prevented with an antibacterial treatment.

SA is commonly present on the skin, including the nose and armpits, and can cause infections if the skin becomes compromised, as can happen during radiation therapy. To investigate the connection between SA and ARD development, researchers collected bacterial cultures from 76 patients with breast or head and neck cancer undergoing curative-intent fractionated radiation therapy at the Montefiore Einstein Cancer Center. The study found that 48.3% of patients who developed severe ARD tested positive for SA colonization after treatment initiation; 17% of those with mild ARD had SA.

A phase 2/3 trial (NCT03883828) was also conducted to investigate the use of an antibacterial regimen that consisted of using 4% chlorhexidine gluconate as a body cleaner along with mupirocin 2% nasal ointment vs standard-of-care treatment in this population. The regimen was administered twice daily for 5 days before radiation treatment, and continued every other week during radiation therapy. The study included 77 participants, 75 of whom had breast cancer and 2 of whom had head and neck cancer.

Results showed that no patients in the antibacterial regimen group developed the most severe form of ARD, moist desquamation, and more than half experienced mild-to-moderate ARD. In contrast, 23.7% of patients in the control group experienced severe ARD.

These findings suggest a potential shift in ARD prevention protocols for individuals undergoing radiation therapy for breast cancer, with the antibacterial regimen offering a more effective and accessible solution.