Treatment of patients with chemotherapy-induced PPE using a prevention ointment containing high concentrations of antioxidants.

Abstract

e19558 Background: The palmar-plantar erythrodysesthesia syndrome (PPE) is a cutaneous side effect often observed in patients under chemotherapy, e.g., with pegylated liposomal doxorubicin. This side effect entails a reduction in the antioxidative potential of the skin due to intensive radical formation. Recently, it was demonstrated that topical treatment of patients with an ointment containing high concentrations of antioxidants is an efficient prevention strategy against PPE when applied before the beginning of chemotherapy. In a 5-year observation period at the Department of Dermatology of the Charité we selected patients, who had developed a PPE during treatment with a variety of chemotherapeutics. The aim of the present study was to investigate whether the antioxidant containing ointment is also suited to treat PPE, which occurred during treatment of 13 types of cancer with chemotherapeutics besides doxorubicin. Methods: In 5 years, 68 patients having developed PPE during treatment with 12 different chemotherapeutics, including pegylated liposomal doxorubicin, capecitabin and sorafenib applied an ointment containing antioxidants with a high radical protection factor (RPF). 46 patients exhibited PPE grade III and 22 patients PPE grade II. All patients were treated with the antioxidant-containing ointment, which was applied at least twice daily in the palmar and plantar regions. Results: Treatment with the antioxidant-containing ointment resulted in a distinct regression or disappearance of PPE. After 4 weeks of treatment the PPE grade III originally diagnosed in 46 patients had reduced to grade II in 6 and to grade I in 33 patients. In 7 patients the PPE had completely disappeared. The PPE grade II diagnosed in 22 patients had alleviated to grade I in 7, and completely disappeared in 15 patients. Conclusions: Obviously, cutaneous side effects entailing radical formation processes are also induced by other types of chemotherapeutics. An antioxidant containing ointment with high RPF is not only suited to prevent PPE in patients under doxorubicin therapy, but is also effective in treating PPE caused by other chemotherapeutics.

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.…”