Evolving Strategies for the Management of Hand–Foot Skin Reaction Associated with the Multitargeted Kinase Inhibitors Sorafenib and Sunitinib

Abstract

The multitargeted kinase inhibitors (MKIs) sorafenib and sunitinib have shown benefit in patients with renal cell carcinoma, hepatocellular carcinoma (sorafenib), and gastrointestinal stromal tumor (sunitinib). Their efficacy in other malignancies is currently being investigated because of their broad range of activity. The effectiveness of these drugs is somewhat diminished by the development of a variety of toxicities, most notably hand-foot skin reaction (HFSR). Although HFSR does not appear to directly affect survival, it can impact qual-

HFS-14, a Specific Quality of Life Scale Developed for Patients Suffering from Hand–Foot Syndrome

“…Several experts highlighted the importance of properly assessing QoL in combination with therapeutic efficacy to help determine the most effective HFS management strategies in patients treated for cancer [9,10,11,14]. If appropriate management is not rapidly implemented, HFS may worsen and QoL impairment may lead to anticancer treatment modification or discontinuation, with the risk for potentially limiting its efficacy [3,23].…”

“…Eight items were allocated to the hands domain (items 1-8), eight items were allocated to the feet domain (items 3 and 5-11), with five of these being allocated both to the hands and feet domains (items 3 and 5-8). The social domain was made up of three items (items [12][13][14]. Two additional questions defined in Patients and Methods were also included in the final questionnaire (Fig.…”

“…Most reports have indicated that severe HFS could lead to significant morbidity and poor patient compliance with cancer treatment [11]. Currently available QoL measurement tools such as the Skindex-16 [12] and the Dermatology Life Quality Index (DLQI) questionnaire [13] can assess skin-related QoL in patients receiving chemotherapy or MKIs [10], but they are not specifically designed for this population [14].…”

Drug therapy: Sorafenib

“…Most drug toxicity can be managed with appropriate use of urea based creams and topical emollients, antiemetics, and antidiarrhea medication. 27,28 Efficacy should be documented with imaging. Computed tomography or magnetic resonance imaging of the chest, abdomen, and pelvis to include areas of active disease should be performed at regular intervals.…”

“…In general, Child-Pugh B patients treated with sorafenib do not live as long as patients with Child-Pugh A, but Table adapted from sorafenib package insert for managing skin toxicities. Treatment strategies for managing skin toxicity and diarrhea can be found in Lacouture et al 27 and Benson et al, 28 respectively. that could very well reflect the natural history of their liver disease rather than a difference in anticancer activity of sorafenib.…”