title: Efficacy of a protocol including heparin ointment for treatment of multikinase inhibitor-induced hand-foot skin reactions.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the efficacy of a protocol including topical heparin therapy for hand-foot skin reactions (HFSR) during multikinase (MKI) treatment.
  
  
  METHODS
  We prospectively collected 26 patients who had HFSRs during treatment with the MKIs, sunitinib, sorafenib, or axitinib. The age distribution ranged from 46 to 87 years, with a mean of 66 years. The distribution of HFSR severity was 12 patients with grade 1, 12 with grade 2, and 2 with grade 3. A heparin-containing topical ointment treatment, combined with hand-foot shock absorbers and skin moisturizers, was used at the lesion sites. Changes in the grade of HFSR, MKI dosage, and interruptions of MKI therapy were recorded.
  
  
  RESULTS
  The results showed that 66.7% of grade 1 patients were cured of disease, 83.3% of grade 2 patients had improved symptoms, and both grade 3 patients (100%) had improved symptoms and were downgraded to grade 2. Four (15.4%) patients required reduction of MKI dosage, but there were no treatment interruptions or dropouts.
  
  
  CONCLUSIONS
  Our protocol is beneficial in promoting resolution of HFSRs induced by MKIs. Further validation in large control studies should be investigated.
authors.affiliation: Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
authors.forename: Jian-ri
authors.initials: JR
authors.lastname: Li
authors.forename: Chi-rei
authors.initials: CR
authors.lastname: Yang
authors.forename: Chen-li
authors.initials: CL
authors.lastname: Cheng
authors.forename: Hao-chung
authors.initials: HC
authors.lastname: Ho
authors.forename: Kun-yuan
authors.initials: KY
authors.lastname: Chiu
authors.forename: Chung-Kuang
authors.initials: CK
authors.lastname: Su
authors.forename: Wen-Ming
authors.initials: WM
authors.lastname: Chen
authors.forename: Shian-Shiang
authors.initials: SS
authors.lastname: Wang
authors.forename: Chuan-Shu
authors.initials: CS
authors.lastname: Chen
authors.forename: Cheng-Kuang
authors.initials: CK
authors.lastname: Yang
authors.forename: Yen-chuan
authors.initials: YC
authors.lastname: Ou
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D000077784:Axitinib; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D060831:Hand-Foot Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007191:Indazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D009824:Ointments; D010671:Phenylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012720:Severity of Illness Index; D000077157:Sorafenib; D000077210:Sunitinib; D016896:Treatment Outcome
chemical_list: D007093:Imidazoles; D007191:Indazoles; D007211:Indoles; D009824:Ointments; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D011758:Pyrroles; D009536:Niacinamide; D006493:Heparin; D000077157:Sorafenib; D000077784:Axitinib; D000077210:Sunitinib