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Annals of Oncology Advance Access published online on June 10, 2008
Annals of Oncology, doi:10.1093/annonc/mdn389
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Hand foot skin reaction in cancer patients treated with the multikinase inhibitors sorafenib and sunitinib

M. E. Lacouture1,2,3,*, L. M. Reilly3, P. Gerami1 and J. Guitart1,2,3

1 Department of Dermatology, SERIES Clinic
2 Robert H Lurie Comprehensive Cancer Center
3 Northwestern University's Feinberg School of Medicine, Chicago, USA

* Correspondence to: Dr M. E. Lacouture, Department of Dermatology, Northwestern University's Feinberg School of Medicine, 676 North St Clair Street, Suite 1600, Chicago, IL 60611, USA. Tel: +1-312-695-8106; Fax: +1-312-695-0664; E-mail: m-lacouture{at}northwestern.edu

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.

hand foot skin reaction, sorafenib, sunitinib

Received for publication December 20, 2007. Revision received May 13, 2008. Accepted for publication May 15, 2008.


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