Search for evidence-based approaches for the prevention and palliation of hand-foot skin reaction (HFSR) caused by the multikinase inhibitors (MKIs).
BACKGROUND
The anticancer multikinase inhibitors (MKIs) are associated with cutaneous adverse events, including hand-foot skin reaction (HFSR), a condition affecting 20%-40% of patients. Symptoms are usually mild, but can evolve into a painful condition that limits function and impacts quality of life (QoL), resulting in shortened cancer treatment duration or intensity. The goal of this study was to systematically review the literature on the prevention and palliation of MKI-associated HFSR, to identify areas for further clinical study, and to provide a foundation for evidence-based guidelines for HFSR management.


METHODS
Systematic searches of the National Library of Medicine's PubMed database, Cochrane Reviews, BIOSIS, CancerLit, and the American Society of Clinical Oncology website were conducted using search terms for cutaneous toxicities associated with chemotherapeutic agents. Articles were categorized (C) based on type of agent and cutaneous reaction as: C1 (MKI and HFSR); C2 (MKI and other cutaneous toxicity); C3 (other antineoplastic agents and HFSR); and C4, other.


RESULTS
Of the 2,069 abstracts screened, 350 (17%) met the criteria for C1-C4, with 56 (16%) coded as C1 with details of HFSR histology, pathogenesis, clinical outcome, QoL impact, and/or prevention and treatment approaches in MKI-treated patients. No randomized, controlled trials (RCTs) on prevention/palliation of HFSR were identified. Anecdotal evidence or expert opinion advocated protective measures, preventive and therapeutic skin care, systemic analgesics for pain, vitamin B(6), and MKI dose modification.


CONCLUSIONS
No articles containing evidence from RCTs on preventive/palliative approaches to MKI-associated HFSR have been published. Systematic study of optimal treatment strategies for HFSR is needed to advance development of evidence-based treatment guidelines.
Anderson
Roger
R
Penn State University College of Medicine, Hershey, PA, USA. randerso@hes.hmc.psu.edu
Jatoi
Aminah
A
Robert
Caroline
C
Wood
Laura S
LS
Keating
Karen N
KN
Lacouture
Mario E
ME
D003875:Drug Eruptions / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D005533:Foot Dermatoses / Q000139:chemically induced* / Q000517:prevention & control / Q000628:therapy*; D006229:Hand Dermatoses / Q000139:chemically induced* / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D010166:Palliative Care / Q000379:methods; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*
D047428:Protein Kinase Inhibitors