Application of an ointment with high radical protection factor as a prevention strategy against PPE.

Abstract

5064 Background: Pegylated liposomal doxorubicin has proved to be highly efficient in the treatment of various tumors. Depending on the application protocol, up to 80% of patients develop palmar-plantar erythrodysesthesia (PPE). So far, a prevention strategy is still unknown. Recently, it was shown that parts of the chemotherapeutics were excreted with the sweat onto the skin surface, spreading there homogeneously and penetrating into the stratum corneum. The formation of free radicals in the tissue results in PPE. The aim of the study was to investigate if a topically applied ointment containing antioxidants with high radical protection factor (RPF) can be a PPE prevention strategy. Methods: 20 patients with ovarian carcinoma, who had been treated with pegylated liposomal doxorubicin (40 mg/m2), were investigated. They applied the ointment at least twice daily, 2 days before and during 3 cycles of chemotherapy. Their skin condition was examined by a trained dermatologist. Results: From 20 patients enrolled in the study, only 12 (60%) met the conditions by applying the cream at least twice daily in the palmar and plantar regions. These patients did not develop PPE. One patient died in the 2nd cycle of therapy. 7 patients (35%) did not follow the ointment application protocol for various reasons; 6 of them developed PPE and resumed ointment application thereafter. As a result, PPE disappeared or was strongly reduced in these patients so that chemotherapy could be continued. Due to the small group of patients, the fact that PPE was not induced in patients who had applied the ointment regularly can be generalized only restrictedly. Far more interesting are the findings in those patients, who had stopped ointment application during chemotherapy and developed PPE, which disappeared after they resumed applying the ointment. The regression or distinct reduction of PPE after re-application of the ointment clearly proves the efficacy of this strategy. Conclusions: The topical application of an ointment containing antioxidants with high radical protection factor (RPF) could be an efficient strategy against the development of PPE during chemotherapy.

In vivo detection of changes in cutaneous carotenoids after chemotherapy using shifted excitation resonance Raman difference and fluorescence spectroscopy

“…The measurement system could be used for the indication to initiate a prevention strategy of cutaneous toxicities in the form of topical application of antioxidants. 29,30 The results obtained show that some of the fluorescence-active chemotherapeutic agents, for example, doxorubicin or epirubicin can be detected due to enhanced skin fluorescence as expected. 31 The direct detection and identification of all fluorescence-free chemotherapeutic agents in the skin using SERRDS was not observed within this study and can be subjected to further investigations.…”

“…In summary, the applied SERRDS measurements showed excretion of intravenous chemotherapeutic agents on the skin surface by simultaneously analyzing the carotenoid antioxidants and the fluorescence in the skin. The measurement system could be used for the indication to initiate a prevention strategy of cutaneous toxicities in the form of topical application of antioxidants …”

Capecitabine-associated hand–foot–skin reaction is an independent clinical predictor of improved survival in patients with colorectal cancer

“…The latter was demonstrated to be caused by the excretion of parts of cytotoxic agents with the sweat onto the skin surface spreading there homogeneously and penetrating into the stratum corneum. This led to disturbance preferably in ‘vulnerable' body areas with thick stratum corneum such as the palm and the planta ( Kluschke et al , 2012 ; Lademann et al , 2012 ). Having said, this may point towards new prophylactic measures for the prevention of HFSR using antioxidant containing ointments with high radical protection factor.…”

Carotenoids in Human Skin In Vivo: Antioxidant and Photo-Protectant Role against External and Internal Stressors

“…It was assumed that the preventive topical application of antioxidants can neutralize the formed ROS within the SC before they can destroy cells or cell compartments. In a pilot study on 20 patients that were diagnosed with ovarian cancer that were treated with pegylated liposomal doxorubicine (40 mg/m 2 , 4 cycles) [ 229 ], it was shown that the topical application of a cream containing a balanced antioxidant mixture (Mapisal, Medac GmbH, Wedel, Germany) twice daily can significantly reduce the occurrence and severity of PPE [ 230 ]. The antioxidant mixture that was used in the cream was characterized by a very high free radical protection factor of 4500 × 10 14 radicals/mg.…”