Elsevier

Annals of Oncology

Volume 19, Issue 11, November 2008, Pages 1955-1961
Annals of Oncology

original articles
supportive care and palliative care
Hand foot skin reaction in cancer patients treated with the multikinase inhibitors sorafenib and sunitinib

https://doi.org/10.1093/annonc/mdn389Get rights and content
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Abstract

Background

This study examined clinicopathological findings and management of hand foot skin reaction (HFSR) to sorafenib and sunitinib in a dermatology referral center for cancer-related toxic effects.

Patients and methods

We identified 12 patients who developed HFSR in a 1-year period (2007). Medical records and histological specimens were investigated for clinicopathological data and results on management.

Results

We identified 12 patients developing HFSR on treatment with sorafenib (83%) or sunitinib (17%). Majority presented with grade 3 (75%) HFSR and a median Skindex score of 43. Biopsies in seven patients showed horizontal layers of keratinocyte necrosis, which correlated to time of drug exposure: early (<30 days from initiation) leading to stratum granulosum–spinosum alterations and late (≥30 days) resulting in stratum corneum pathology. Treatment with topical urea singly (n = 3), plus tazarotene (n = 7), or fluorouracil (n = 2) resulted in ≥2 grade improvement in the majority of patients (58%), with five patients (42%) improving one grade (P = 0.007). Median Skindex score at follow-up was 32 (P = 0.22).

Conclusions

There are unique clinicopathological characteristics of HFSR due to the multikinase inhibitors that correlate with time of agent initiation. Treatment with topical agents having keratolytic, antiproliferative, and anti-inflammatory properties showed benefit.

Keywords

hand foot skin reaction
sorafenib
sunitinib

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