Clinical Presentation and Management of Hand–Foot Skin Reaction Associated with Sorafenib in Combination with Cytotoxic Chemotherapy: Experience in Breast Cancer

Abstract

Current combination therapies for advanced breast cancer provide a modest survival benefit but with greater toxicity than with monotherapies. New combinations are needed that improve the efficacy of current treatments and have acceptable tolerability profiles. Recent clinical trials have assessed the efficacy and safety of the multikinase inhibitor sorafenib in combination with common treatments for advanced breast cancer. Sorafenib has both antiangiogenic and antiproliferative activities and is indicated for patients with unresectable hepatocellular and advanced renal cell carcinoma. Generally, sorafenib is associated with manageable, non-life-threatening adverse events. One of the more common adverse events seen with sorafenib is handfoot skin reaction, a dermatologic toxicity usually localized to the pressure points of the palms and soles. Although hand-foot skin reaction is reversible and not life threatening, it can have a significant impact on a patient's quality of life and may necessitate dose modification. Moreover, sorafenib is being evaluated in combination with breast cancer treatments that are associated with a similar dermatologic toxicity (e.g., capecitabine-induced hand-foot syndrome). This review looks at the use of sorafenib in combination with selected chemotherapies in patients with advanced breast cancer and considers the incidence, prevention, and management of hand-foot skin reaction. The Oncologist 2011;16:1508 -1519

Optimizing Treatment Outcomes With Regorafenib: Personalized Dosing and Other Strategies to Support Patient Care

“…Table 5. Grading of hand-foot skin reaction symptoms, based on National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 for palmar-plantar erythrodysesthesia syndrome [11] Grade Symptoms Impact on daily activities …”

“…Health care staff should frequently examine patients and encourage them to discuss any skin concerns to ensure early diagnosis of skin toxicities, particularly within the first 2 months of therapy. Table 5 shows the standardized NCI-CTCAE version 4.0 grading for dermatologic toxicities, which may be helpful in guiding treatment decisions [11,17,18,25]. However, these criteria were not developed specifically for skin symptoms associated with targeted therapies.…”

Sorafenib-induced dermatologic Grade III toxicity: An important clinical manifestation

“…There are evidence suggesting prophylactic use of pyridoxine for hand-foot skin reactions. [13] These skin reactions can be managed by the use of moisturizers, corticosteroids, and keratolytics (salicylic acid). [14] …”

Sorafenib Induced Hand and Foot Syndrome

“…[1][2][3][4][5][6][7][8] It is a multikinase inhibitor (tyrosine kinase, Raf serine / threonine kinases). It also inhibits vascular endothelial growth factor (VEGF), platelet -derived growth factor β (PDGF β), and tumour progression.…”

“…It also inhibits vascular endothelial growth factor (VEGF), platelet -derived growth factor β (PDGF β), and tumour progression. 2,[3][4][5][6][7][8][9] Adverse reactions to sorefinib are gastrointestinal (diarrhoea, increased amylase and lipase, nausea, constipation), dermatological (acne, flushing, rash / desquamation, hand -foot syndrome (HFD), alopecia, pruritus), hyperthyroidism, hypertension and hypoalbuminemia.…”