Prevention strategies in palmar-plantar erythrodysesthesia onset: the role of regional cooling.
OBJECTIVE
Palmar-plantar erythrodysesthesia (PPE) is a characteristic cutaneous toxicity associated with pegylated liposomal doxirubicin (PLD). Different therapies have been proposed to alleviate PPE onset. We performed a prospective study to evaluate preventive strategies to reduce PPE incidence in patients treated for gynecologic cancers.


METHODS
Fifty-three patients were treated from 2001 to 2006 with PLD as single agent therapy or in combination with carboplatin or paclitaxel. PLD dosages were in the range of 30-50 mg/m2 every 21-28 days. All patients received premedication with dexamethasone and pyridoxine. Twenty-eight patients received application of ice packs on extremities during PLD infusion.


RESULTS
PPE was observed in 11 patients (20.8%). PLD administration as single agent or in combination and schedule of PLD therapy did not affect PPE incidence. A significant reduction in PPE onset was observed if PLD dosage was 30-35 mg/m2 (p=0.03) and when patients were submitted to regional cooling protocol (p=0.0097).


CONCLUSIONS
The use of ice packs around wrists and ankles is a simple and well tolerated prevention strategy and its efficacy is demonstrated in this study.
Mangili
G
G
IRCCS Ospedale San Raffaele, Obstetrics and Gynecology Department, Milan, Italy. mangili.giorgia@hsr.it
Petrone
M
M
Gentile
C
C
De Marzi
P
P
Viganò
R
R
Rabaiotti
E
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004890:Erythema / Q000139:chemically induced / Q000517:prevention & control*; D005260:Female; D005533:Foot Dermatoses / Q000139:chemically induced / Q000517:prevention & control*; D005833:Genital Neoplasms, Female / Q000150:complications / Q000188:drug therapy; D006229:Hand Dermatoses / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D010292:Paresthesia / Q000139:chemically induced / Q000517:prevention & control; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies
C506643:liposomal doxorubicin; D011092:Polyethylene Glycols; D004317:Doxorubicin