title: Strategies for assessing and managing the adverse events of sorafenib and other targeted therapies in the treatment of renal cell and hepatocellular carcinoma: recommendations from a European nursing task group.
abstract: OBJECTIVE
  As a group of European nurses familiar with treating patients with renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC) using targeted/chemo- therapies, we aimed to review strategies for managing adverse events (AEs) associated with one targeted therapy, sorafenib.
  
  
  METHODS
  Focusing on the AEs we considered the most difficult to manage (hand-foot skin reaction [HFSR], diarrhoea, fatigue and mucositis/stomatitis), we reviewed the literature to identify strategies relevant to sorafenib. Given the paucity of published work, this included strategies concerning targeted agents in general. This information was supplemented by considering the wider literature relating to management of these AEs in other tumour types and similar toxicities experienced during conventional anti-cancer therapy. Together with our own experience, this information was used to compile an AE management guide to assist nurses caring for patients receiving sorafenib.
  
  
  RESULTS
  Our collated experience suggests the most commonly reported AEs with sorafenib and other targeted agents are HFSR, diarrhoea, fatigue, rash and mucositis/stomatitis; these generally have an acute (appearing at ∼0-1 months) or delayed onset (appearing at ∼3 months). Most management strategies in the literature were experience-based rather than arising from controlled studies. However, strategies based on controlled studies are available for HFSR and mucositis/stomatitis.
  
  
  CONCLUSIONS
  Evidence, especially from controlled studies, is sparse concerning management of AEs associated with sorafenib and other targeted agents in RCC/HCC. However, recommendations can be made based on the literature and clinical experience that encompasses targeted and conventional therapies, particularly in the case of non-specific toxicities e.g. diarrhoea and fatigue.
authors.affiliation: 3rd Floor Mulberry House, Fulham Road, London SW3 6JJ, UK. Kim.Edmonds@rmh.nhs.uk
authors.forename: Kim
authors.initials: K
authors.lastname: Edmonds
authors.forename: Diana
authors.initials: D
authors.lastname: Hull
authors.forename: Andrea
authors.initials: A
authors.lastname: Spencer-Shaw
authors.forename: José
authors.initials: J
authors.lastname: Koldenhof
authors.forename: Maria
authors.initials: M
authors.lastname: Chrysou
authors.forename: Christine
authors.initials: C
authors.lastname: Boers-Doets
authors.forename: Alexander
authors.initials: A
authors.lastname: Molassiotis
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D001557:Benzenesulfonates / Q000009:adverse effects*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy; D002292:Carcinoma, Renal Cell / Q000188:drug therapy; D017326:Clinical Trials, Phase III as Topic; D003967:Diarrhea / Q000139:chemically induced / Q000451:nursing*; D003875:Drug Eruptions / Q000209:etiology / Q000451:nursing*; D005060:Europe; D005221:Fatigue / Q000139:chemically induced / Q000451:nursing*; D005533:Foot Dermatoses / Q000139:chemically induced / Q000451:nursing; D006229:Hand Dermatoses / Q000139:chemically induced / Q000451:nursing; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy; D008113:Liver Neoplasms / Q000188:drug therapy; D058990:Molecular Targeted Therapy / Q000009:adverse effects*; D052016:Mucositis / Q000139:chemically induced / Q000451:nursing*; D009536:Niacinamide / Q000031:analogs & derivatives; D009730:Nursing Assessment / Q000379:methods*; D010671:Phenylurea Compounds; D011725:Pyridines / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D012956:Societies, Nursing; D000077157:Sorafenib
chemical_list: D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D010671:Phenylurea Compounds; D011725:Pyridines; D009536:Niacinamide; D000077157:Sorafenib