Topical DMSO treatment for pegylated liposomal doxorubicin-induced palmar-plantar erythrodysesthesia.
OBJECTIVE
Chemotherapeutic regimens that utilize fluorouracil, cytarabine, and doxorubicin have been shown to cause a dermatologic syndrome known as hand-foot syndrome, or palmar-plantar erythrodysesthesia syndrome (PPES). Pegylated liposomal doxorubicin has proven effective in the treatment of AIDS-related Kaposi's sarcoma, ovarian cancer refractory to platinum and paclitaxel therapies, and metastatic breast cancer. In a study of the treatment of refractory epithelial cell ovarian cancers with lipozomal doxorubicin utilizing intravenous doses of 50 mg/m(2) every 3 weeks, grade 3 PPES was observed in 29% of patients (10/35) and required dose reductions and/or dose delay after a median of three therapy cycles.


METHODS
Current methods to prevent pegylated liposomal doxorubicin-induced PPES include dose reduction, lengthening of the drug administration interval and ultimately, drug withdrawal. Topical 99% dimethylsulfoxide (DMSO) also has shown strong activity in treating tissue extravasation reactions during intravenous administration of doxorubicin.


RESULTS
Two patients undergoing chemotherapy with pegylated liposomal doxorubicin, 50 mg/m(2) every 4 weeks, developed grade 3 PPE after three cycles. Their PPES resolved over a period of 1 to 3 weeks while receiving topical 99% DMSO four times daily for 14 days.


CONCLUSIONS
While these results are promising, patients must be treated in a prospective study of this topical DMSO formulation to definitively document its therapeutic efficacy.
Lopez
A M
AM
Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ 85724, USA.
Wallace
L
L
Dorr
R T
RT
Koff
M
M
Hersh
E M
EM
Alberts
D S
DS
D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004317:Doxorubicin / Q000009:adverse effects*; D004890:Erythema / Q000139:chemically induced* / Q000188:drug therapy*; D005260:Female; D005528:Foot; D006225:Hand; D006801:Humans; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D010292:Paresthesia / Q000139:chemically induced* / Q000188:drug therapy*; D011092:Polyethylene Glycols / Q000008:administration & dosage; D013577:Syndrome
D000893:Anti-Inflammatory Agents; D000970:Antineoplastic Agents; D008081:Liposomes; D011092:Polyethylene Glycols; D004317:Doxorubicin; D004121:Dimethyl Sulfoxide