Cutaneous toxicities of the multikinase inhibitors sorafenib and sunitinib

Abstract

Multikinase inhibitors have become first-line agents for treatment of multiple systemic cancers. These agents are very effective but can also cause a variety of toxicities affecting the skin, hair, and nails. One of the most common reactions is the hand-foot skin reaction, distinct from hand-foot syndrome caused by more traditional chemotherapy agents. All of these cutaneous reactions can negatively affect patients' quality of life and can lead to dose modifications and treatment interruptions. This article reviews the cutaneous toxicities from sorafenib and sunitinib with emphasis on treatment strategies.

Current management of patients with gastrointestinal stromal tumor receiving the multitargeted tyrosine kinase inhibitor sunitinib

“…Co. Inc., Lyndonville, VT; creams containing keratolytics 55 , lanolin or urea 54,55,58,59 ); use pain medication 54,55 In erythematous areas, recommend use of steroidal preparations (clobetasol propionate 0.5%) 59 ; pyridoxine and systemic corticosteroids may also be tried 60 (continued ) ) and treat pre-existing hypertension; assess renal status 62,64 Encourage lifestyle modification 64 Measure blood pressure frequently during treatment 22,62 (most frequently during first treatment cycle) 63,64 Maintain regular contact with hypertensive patients to ensure compliance with antihypertensives Standard antihypertensive therapy 22,40,[62][63][64] ; avoid drugs known to interact with CYP3A4 (some CCBs) 40,55,64 and use care with drugs that prolong the PR interval (b-blockers and CCBs) 54 Hypothyroidism Variable 65,66 None generally required 54,55,65,66 Assess thyroid function at baseline 22,54,55 Monitor during sunitinib treatment and if signs or symptoms of hypothyroidism are observed 22,55,66 Treat with thyroid hormone replacement therapy as appropriate 55,65,66 ; treatment should also be considered for patients with subclinical hypothyroidism …”

“…-tight-fitting shoes -tight-fitting jewelry -heavy activity To prevent pressure/friction advise: -loose-fitting clothes 54 -use of orthotic devices 55,58 -use of cosmetic gloves 52,59 or booties where appropriate 59 Advise avoidance of extreme temperatures 52…”

Hand Foot Skin Reaction Associated with Sunitinib

“…Bu evrede günlük aktiviteler kısıtlanmıştır. Evre 3'de ise ağrılı, şiddetli deri değişiklikleri ile birlikte hastanın öz bakım faaliyetleri kısıtlanmıştır (7). Bizim hastamızda palmoplantar bölgelerde ağrılı, etrafı eritemli halo ile çevrili kallus benzeri lezyonlar mevcuttu.…”

“…Evre 1'deki tedavilere ek olarak topikal steroidler, %2 lidokain, ağrı için kodein veya pregabalin verilebilir. Evre 3'de sunitinibe yedi gün ara verilir ve evre 1-2'deki tedavi seçenekleri kullanılır (7). Biz hastamızda evre 3 el ayak deri reaksiyonu tanısı ile sunitinib tedavisine iki hafta ara verip, topikal olarak üreli nemlendirici ile orta potens kortikosteroid tedavisi uyguladık.…”

Sneddon-Wilkinson Disease Induced by Sorafenib in a Patient with Advanced Hepatocellular Carcinoma

“…The administration of sorafenib has been shown to be effective for treating advanced hepatocellular carcinoma (HCC) (2,3) and has become a standard therapy for this disease (1). However, sorafenib has also been shown to cause many adverse dermatological effects, including hand-foot skin reaction (HFSR), alopecia, erythema and Steven-Johnson syndrome (4,5).…”