Colorectal cancer (CRC) is an important public health issue, in terms of incidence and mortality, with approximately 1.8 million new cases reported worldwide in 2018. Advancements in understanding pathophysiological key steps in CRC tumorigenesis have led to the development of new targeted therapies such as those based on epidermal growth factor receptor inhibitors (EGFR inhibitors). The cutaneous adverse reactions induced by EGFR inhibitors, particularly papulopustular rash, often require long-term antibiotic treatment with tetracycline agents (mostly minocycline and doxycycline). However, this raises several issues of concern: possible occurrence of gut dysbiosis in already vulnerable CRC patients, selection of highly antibiotic resistant and/or virulent clones, development of adverse reactions related to tetracyclines, interference of antibiotics with the response to oncologic therapy, with a negative impact on disease prognosis etc. In the context of scarce information regarding these issues and controversial opinions regarding the role of tetracyclines in patients under EGFR inhibitors, our aim was to perform a thorough literature review and discuss the main challenges raised by long-term use of tetracyclines in advanced CRC patients receiving this targeted therapy.

Department of Dermatology 'Elias' Emergency University Hospital 011461 Bucharest Romania

Department of Dermatology and Venereology Charles University Medical School and Teaching Hospital Pilsen 30599 Pilsen Czech Republic

Department of Genetics Faculty of Biology ICUB Research Institute of the University of Bucharest 050657 Bucharest Romania

Department of Microbiology Faculty of Biology ICUB Research Institute of the University of Bucharest 050657 Bucharest Romania

Department of Microbiology Faculty of Medicine 'Carol Davila' University of Medicine and Pharmacy 020021 Bucharest Romania

Department of Oncologic Dermatology 'Elias' Emergency University Hospital 'Carol Davila' University of Medicine and Pharmacy 020021 Bucharest Romania

Department of Oncology 'Elias' Emergency University Hospital 'Carol Davila' University of Medicine and Pharmacy 020021 Bucharest Romania

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