title: Palmar-plantar erythrodysesthesia due to docetaxel-capecitabine therapy is treated with vitamin E without dose reduction.
abstract: Palmar-plantar erythrodysesthesia (PPE) is a distinctive and relatively frequent toxic reaction related to some chemotherapeutic agents. Doxorubicin, cytarabine, docetaxel, fluorouracil, and capecitabine are the most frequently implicated agents. Recently, taxanes, especially docetaxel, have been widely used in combination with capecitabine in patients with metastatic breast cancer (MBC). A high percentage of PPE has been seen in patients undergoing this combination therapy. PPE seems to be dose dependent and both peak drug concentration and total cumulative dose determine its occurrence. Withdrawal or dose reduction of the implicated drug usually gives rise to amelioration of the symptoms. Supportive treatments such as topical wound care, elevation, and cold compresses may help to relieve the pain. Use of systemic corticosteroids, pyridoxine (vitamin B6), blood flow reduction, and, recently, topical 99% dimethyl-sulfoxide have been used with variable outcomes. Vitamin E treatment has not been published before, especially without dose reduction of docetaxel-capecitabine therapy. Here we present five MBC patients treated with docetaxel-capecitabine combination therapy in whom PPE was observed during the clinical follow-up period. In all patients grade 2-3 PPE was observed. Vitamin E therapy was started at 300 mg/day p.o. without dose reduction of therapy and after 1 week of treatment PPE began to disappear. We suggest that it could be of interest to consider vitamin E as a preventive drug when drugs with a strong association with PPE are going to be administered.
authors.affiliation: Department of Medical Oncology, Faculty of Medicine, Cukurova University, Balcali Hospital, 01330 Yuregir-Adana, Turkey. iokara@cu.edu.tr
authors.forename: Ismail Oguz
authors.initials: IO
authors.lastname: Kara
authors.forename: Berksoy
authors.initials: B
authors.lastname: Sahin
authors.forename: M
authors.initials: M
authors.lastname: Erkisi
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology; D000069287:Capecitabine; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000556:secondary; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000077143:Docetaxel; D004890:Erythema / Q000139:chemically induced* / Q000517:prevention & control; D017809:Fatal Outcome; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives; D005528:Foot; D006225:Hand; D006801:Humans; D008875:Middle Aged; D010292:Paresthesia / Q000139:chemically induced* / Q000188:drug therapy* / Q000517:prevention & control; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects*; D014810:Vitamin E / Q000627:therapeutic use*
chemical_list: D000964:Antimetabolites, Antineoplastic; D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D003841:Deoxycytidine; D014810:Vitamin E; D000077143:Docetaxel; D000069287:Capecitabine; D005472:Fluorouracil