Nail changes due to docetaxel--a neglected side effect and nuisance for the patient

Prevention of taxane chemotherapy-induced nail changes and peripheral neuropathy by application of extremity cooling: a prospective single-centre study with intrapatient comparison

PURPOSE

Common side effects of taxane chemotherapy are nail toxicity and peripheral neuropathy (CIPN) causing severe impact on the quality of life. Different methods of cryotherapy to prevent these side effects have been tested. We investigated the use of machine-controlled cooling of hands and feet to reduce nail toxicity and CIPN in patients receiving taxane chemotherapy.

METHODS

Patients receiving Docetaxel (planned dose ≥ 300 mg/m2) or Paclitaxel (planned dose ≥ 720 mg/m2 - ) in the adjuvant or palliative setting of different cancers were included. The dominant hand and foot were cooled to approximately 10 °C using the Hilotherapy machine. The contralateral hand and foot were used as intrapatient comparison. The primary endpoint was the occurrence of any CIPN due to paclitaxel or nail toxicity due to Docetaxel. Both the intention to treat population (ITT) and the per protocol population (PPP) were analyzed.

RESULTS

A total of 69 patients, 21 treated with Docetaxel and 48 with Paclitaxel, were included at our centre between 08/2020 and 08/2022. Nail toxicity due to Docetaxel was overall not significantly improved by cooling in the ITT or PPP but a significant benefit across visits was found for the ITT. CIPN due to Paclitaxel was numerically better in the ITT and significantly better in the PPP. A significant benefit of cooling on CIPN occurrence across visits was found for the ITT and the PPP. Cooling was very well tolerated.

CONCLUSION

Cooling of hands and feet has a clinically meaningful impact on reducing occurrence of CIPN and nail toxicity on treatment with taxanes. Effects are more significant over time and are dose dependent.

TRIAL REGISTRATION NUMBER

2020-00381. Date of registration. 24th February 2020.

Impact of Chemotherapy-Induced Nail Changes on Quality of Life: A Cross-Sectional Study from a Tertiary Care Centre

Background

Chemotherapy has increased survival rate in patients but is associated with systemic as well as cutaneous adverse effects. Among cutaneous adverse effects, nail changes caused by chemotherapy are often overlooked. But these changes are a major cause of cosmetic concern and negatively affect the quality of life (QoL) of patients.

Aim

This study was conducted to evaluate the impact of chemotherapy-induced nail changes on QoL of patients with malignancy and to compare the severity of impact on QoL in various nail changes.

Materials and Methods

This hospital-based cross-sectional observational study was conducted for a period of 12 months. Only patients on chemotherapy who developed nail changes were included in the study. A nail-specific QoL questionnaire was used. Statistical analysis was conducted to evaluate the impact of nail changes on QoL.

Results

The mean QoL score of 188 patients was 32.37 ± 7.9. The mean QoL score of females was more than that of males. QoL was statistically more significant in younger age groups [<20 years: 46.71 ± 1.7] (P < 0.001). Patients with pigmentary nail changes (melanonychia and leukonychia) had more significant impact on QoL (P < 0.001).

Conclusion

There is a significant impact of chemotherapy-induced nail changes on QoL of patients leading to psychological distress, reduced self-confidence and social limitation. This highlights the importance of proper counselling of patients beforehand regarding the possibility of associated nail changes during and after the chemotherapy regimens.

Foot health and quality of life in women with breast cancer undergoing chemotherapy: a cross-sectional study

BACKGROUND

Chemotherapy is one of the most widely used therapies for breast cancer, triggering important repercussions on people's quality of life. However, little research has been undertaken about podiatric adverse effects. This study aimed was to determine the prevalence of podiatric pathology developed in people with breast cancer who receive chemotherapy.

METHODS

Observational, descriptive, and cross-sectional study was conducted in the Oncology service of the A Coruña University Hospital (northwest Spain). People with breast cancer and undergoing chemotherapy treatment of legal age (≥ 18), who signed the informed consent (n = 117) were included. Sociodemographic, comorbidity, disease and foot health variables, as well as two self-administered questionnaires (Foot Health Status Questionnaire and Foot Function Index) were studied. The current ethical-legal aspects were followed.

RESULTS

Foot health problems were highly prevalent, highlighting nail color changes (59.8%), onychocryptosis (39.7%), xerosis (62.4%), plantar fasciitis (12.8%), and neuropathic symptoms (75.2%). Some foot pain was presented in 77.8% of the sample, predominantly at nail level (15.4%) or sole of the foot and nail (14.5%). Most participants described their foot health as fair or poor (56.4%) and felt limited in walking (65.8%). The lowest score for the Foot Health Status Questionnaire was footwear (30.6(33.5)).

CONCLUSIONS

Foot health adverse effects represent worrisome problems in women with breast cancer undergoing chemotherapy, due to their high prevalence and negative implications on quality of life. These problems are critical as they may have implications for stopping or reducing chemotherapy. All these results call for the development of more research to contribute to the care and wellbeing of people with cancer who receive treatments such as chemotherapy. Thus, this line of research is a new path to be developed by the podiatry community.

Foot Health in People with Cancer Undergoing Chemotherapy: A Scoping Review

BACKGROUND

Chemotherapy has relevant implications for cancer patients' physical, social, and psychological health. Foot health has gained relevance in recent years due to its importance to independence and wellbeing, especially in chronic conditions. This study aims to explore the scope of the literature regarding foot health problems in people with cancer undergoing chemotherapy.

METHODS

scoping review following the PRISMA-ScR, Arksey and O'Malley, and the Joanna Briggs Institute guidelines. Different databases were used (Cochrane Plus, Scopus, Web of Science, and Pubmed). A total of 4911 articles were identified. Finally, 11 papers were included.

RESULTS

Foot problems are relevant and deteriorate wellbeing. The prevalence of some podiatric pathologies is controversial. The main literature deals with hand-foot syndrome and peripheral neuropathy. Focused instruments on foot health were not thoroughly used.

CONCLUSION

There is insufficient evidence on foot health problems and their influence on the quality of life of people with cancer undergoing chemotherapy. Even though a significant percentage of this population has a foot problem, its care and importance are neglected. More studies are needed to contribute to the care of people with cancer through foot health.

A randomised controlled trial of interventions for taxane-induced nail toxicity in women with early breast cancer

Onycholysis and paronychia has been associated with chemotherapy treatment for women with breast cancer. Our primary aim was to investigate the effectiveness of different topical interventions to ameliorate nail toxicity. Secondary aims were to explore the full range and severity of possible nail changes associated with taxane-based chemotherapy and the specific impact this had on quality of life, using two novel measures. This was an exploratory randomised controlled trial of three topical interventions (standard care, nail polish or specialist nail drops) for the prevention or reduction of nail changes induced by taxane-based chemotherapy. Outcomes included nail toxicity assessed at three time points (baseline, 3 weeks and 3 months post completion of chemotherapy) using two novel clinical tools (NToX-G12, NToX-QoL) and the Common Terminology Criteria for Adverse Events (CTCAE v3) and EQ-5D-5L. A total of 105 women were recruited (35 in each arm) and monitored up to three months post completion of chemotherapy. Almost 20% of patients were over the age of 60 years. There were 26 withdrawals, the majority from the nail polish arm. Residual Maximum Likelihood REML analysis indicated a significant arm, time and interaction effect for each intervention (p < 0.001). Less nail toxicity was observed in patients receiving specialist nail drops or standard care arms in comparison to those using nail polish. This study provides evidence to support clinicians’ suggestions on nail care recommendations based on the patients’ needs and preferences. Future investigations into comparing or combining cryotherapy and topical solutions that can support patient’s decisions are warranted.

Nail Changes With Chemotherapeutic Agents and Targeted Therapies

Patients on Cancer chemotherapeutic agents often develop nail changes most of which are only cosmetic concern and disappear on drug withdrawal. But some nail changes can be painful and disabling thereby affecting quality of life substantially. Different components of the nail unit include the nail matrix, nail bed, nail plate, the hyponychium, lunula, the proximal and lateral nail folds. In this article we review the nail changes induced by chemotherapeutics and targeted anticancer drugs, preventive measures and treatment options available.

Toxicity profile of taxanes in Tunisian cancer patients: A retrospective study of 90 cases

INTRODUCTION

Taxanes are widely used in medical oncology. The aim of our study was to report and analyze the toxicity features of these drugs in Tunisian patients and to determine their impact on treatment response.

METHODS

Our retrospective study concerned 90 patients treated by taxanes in a medical oncology unit, from January 2014 to January 2017. We collected their epidemiologic and anatomo-clinical data and we detailed toxicity features including types grades and impact on tumor response.

RESULTS

Median age was 46 years. 80% of patients had breast cancer. Tumors were metastatic in 23.3% of cases. Nail toxicity was observed in 100% of patients. Grade I-II digestive toxicity was observed in 54.4% of cases. Hematological toxicity was noted in 42.2% of patients and it reached grade III-IV in five patients. Neurological toxicity occurred in 31% of patients and was grade III-IV in 6 cases. Alopecia was observed in 60% of patients. Fatigue was noted in 57.8% of patients. Myalgia was observed in 42.2% of patients. Toxicity did not affect the response to treatment.

CONCLUSION

The taxanes' toxicity profile in Tunisian patients is characterized by more frequent digestive and nail toxicities and less frequent hematological toxicities, dose reduction and treatment delays than other populations.

Dermatologic adverse effects of breast cancer chemotherapy: a longitudinal prospective observational study with a review of literature

BACKGROUND

Breast cancer patients may experience an increased chance of survival with adjuvant chemotherapy. However dermatologic adverse effects can cause major discomfort due to physical or cosmetic problems. This study aims to describe dermatologic complications in breast cancer patients during chemotherapy.

METHODS

This longitudinal prospective observational study included data on women with non-metastatic breast cancer whom were treated with AC-T protocol (anthracycline, cyclophosphamide, and taxane) adjuvant chemotherapy and consecutively enrolled during two years. The study was performed in an educational and tertiary referral center. The patients' information including age, body mass index (BMI), past medical history, and different dermatologic complications were collected for all participants.

RESULTS

Of 190 enrolled women, all patients experienced alopecia, which occurred in 131 patients (68.9%) after the first cycle. Skin, mucosal, and nail involvement were respectively seen in 46 (24.2%), 51 (26.8%), and 86 (45.2%) cases. Cutaneous complications were observed mainly between the third and sixth chemotherapy cycles. Palmoplantar erythema and palmoplantar dysesthesia were the most common cutaneous complications. Dermatologic adverse effects were significantly more frequent in the patients with an underlying disease.

CONCLUSION

These findings suggest that dermatologic adverse effects of adjuvant chemotherapy are common and could be induced by all components of AC-T regimen. These complications should be skillfully managed to increase patients' comfort.

Nail Changes Induced by Chemotherapeutic Agents

INTRODUCTION

Nail toxicity is a relatively uncommon cutaneous adverse effect of chemotherapeutic agents. Rapidly dividing cells of the nail matrix are perturbed by the antimitotic activity of these agents. Although most of these changes are cosmetic and regress once the therapy is completed, a few of these adverse effects are challenging to manage and require temporary or permanent suspension of chemotherapeutic agents.

MATERIALS AND METHODS

A total of 205 patients with various malignancies and under chemotherapy in oncology ward of the hospital over a period of 3 months were screened for nail involvement postchemotherapy. Relevant details, protocol of chemotherapeutic agents were assessed. Nail examination was carried out in daylight and the changes were analyzed.

RESULTS

A total of 124 (60.4%) patients had nail changes due to chemotherapeutic agents. The most common change was diffuse hyperpigmentation in 101 (81.4%) patients commonly due to a combination of cyclophosphamide and adriamycin in 43 (42.5%) patients. Longitudinal melanonychia was seen in 36 (29%), Beau's lines in 31 (25%), onychomadesis in 17 (13.7%), Mees' lines in 15 (12%), paronychia in 12 (9.6%), subungual hyperkeratosis in 10 (8%), and Muehrcke's lines in 4 (3.2%) patients. All the patients who developed Muehrcke's lines were on a combination of cyclophosphamide/doxorubicin/5 FU. Exudative onycholysis was observed in 2 (1.6%) patients; both these patients were on paclitaxel therapy. A total 2 (1.6%) patients who developed exudative onycholysis were advised discontinuation and another substitute chemotherapy was advised. Therapy for 2 (1.6%) patients who developed acute paronychia due to gefitinib was temporarily suspended. Unfortunately, most of the patients were on multiple chemotherapeutic agents hence, we could not pinpoint one drug as a cause. Therefore, a combination of agents was implicated in most cases.

CONCLUSION

Nail toxicities are common with chemotherapeutic agents, however less importance is given to nail involvement. Apart from being cosmetically significant, a few adverse effects may warrant modification of the chemotherapy.

Dermatologic conditions in women receiving systemic cancer therapy

As advances in cancer therapies have improved cancer-related survival, novel therapeutics have also introduced a variety of dermatologic toxicities, and an increased number of patients are living with these sequalae. Women with cancer in particular experience a spectrum of dermatologic conditions that affect their skin, hair, nail, and mucosal surfaces. Studies have shown that these toxic effects can significantly affect quality of life and alter a woman's self-image, cultural identity, femininity, sexuality, and mental health. In severe instances, dermatologic toxicities may even disrupt cancer therapy and can therefore affect overall survival and treatment response. In this article, we review the dermatologic adverse effects from traditional chemotherapy, targeted therapy, immune checkpoint inhibitors, and endocrine therapy that disproportionately affect women. The timely diagnosis and management of these dermatologic conditions is crucial in the multidisciplinary care of women with cancer.

Systemic Drug-induced Chronic Paronychia and Periungual Pyogenic Granuloma

Paronychia is a painful inflammatory disorder of the nail fold. Periungual pyogenic granuloma - a benign vascular tumor of the capillaries - can develop as a complication of paronychia. We report both, paronychia and periungual pyogenic granuloma, as possible adverse events during systemic drug-therapy. The following groups of systemic drugs have been considered: taxanes, epidermal growth factor-receptor (EGFR) inhibitors, EGFR tyrosine kinase inhibitors, tyrosine kinase inhibitors, inhibitors of MEK/ERK, BRAF inhibitors, CD20 antagonists, vascular endothelial growth factor inhibitors, and retinoids. Recommendations for prevention and treatment are given. Since paronychia is a painful inflammatory disorder that has a negative impact on daily activities, early recognition and adequate treatment improve adhesion to treatment and quality of life.

[Integrated podiatrist care for prostate cancer patients treated with docetaxel: Feasibility and results]

BACKGROUND

Docetaxel is frequently used for the treatment of metastatic prostate cancer patients. Nail toxicity is a commonly described side effect, but no precise recommendation exists concerning its management. We experimented the integration of a podiatrist in routine cancer care.

METHODS

Patients having received docetaxel for a metastatic prostate cancer since the arrival of the podiatrist were studied.

RESULTS

Fifty-six patients were included, half had docetaxel-induced nail toxicity and 18 were referred to the podiatrist. The integration of the podiatrist in routine care was feasible and allowed characterizing nail toxicity. The main lesions observed were non-coagulated nail hematomas, coagulated nail hematomas and onycholysis. This experience led to propose an integrated care for docetaxel-induced nail toxicity.

CONCLUSION

The integration of podiatrist care is feasible in routine cancer care and can help improving the management of docetaxel-induced nail toxicity in metastatic prostate cancer patients.

Prevalence of dermatological complaints in patients undergoing treatment for breast cancer

BACKGROUND

Internal malignancies such as breast cancer, as well as their treatment can often result in skin changes.

OBJECTIVE

To assess the prevalence of dermatological complaints in patients who are undergoing oncological treatment for breast cancer in a hospital in Tubarão, Santa Catarina, Brazil.

METHODS

Observational, cross-sectional study, from October 2015 to February 2016 in which 152 patients with the diagnosis of breast cancer, undergoing treatment with chemotherapy, radiotherapy, hormone therapy and/or surgery, were interviewed and completed a research protocol developed by the author.

RESULTS

The treatment of breast cancer was associated with dermatological complaints in 94.1% of the interviewed, being with hair loss the most frequent, present in 79.6% of the sample, followed by nail changes (56%). Patients with lighter skin phototypes (I, II and III) had a lower risk (p=0.045) of developing skin changes when compared to darker phototypes. Radiation therapy (p=0.011) and oncological surgery (pFisher=0.004) were statistically significant when related to skin changes.

STUDY LIMITATIONS

Inherent to the design of the study, as well as recall bias.

CONCLUSIONS

It was found that most patients diagnosed with breast cancer showed dermatologic manifestations during the proposed cancer treatment. Patients undergoing radiotherapy and surgery showed skin changes with greater statistical significance.

Dermatological adverse events with taxane chemotherapy

Taxanes (docetaxel and paclitaxel) are among the most commonly prescribed anticancer drugs approved for the treatment of metastatic or locally advanced breast, non-small cell lung, prostate, gastric, head and neck, and ovarian cancers, as well as in the adjuvant setting for operable node-positive breast cancers. Although the true incidence of dermatological adverse events (AEs) in patients receiving taxanes is not known, and has never been prospectively analysed, they clearly represent one of the major AEs associated with these agents. With an increase in the occurrence of cutaneous AEs during treatment with novel targeted and immunological therapies when used in combination with taxanes, a thorough understanding of reactions attributable to this class is imperative. Moreover, identification and management of dermatological AEs is critical for maintaining the quality of life in cancer patients and for minimizing dose modifications of their antineoplastic regimen. This analysis represents a systematic review of the dermatological conditions reported with the use of these drugs, complemented by experience at comprehensive cancer centres. The conditions reported herein include skin, hair, and nail toxicities. Lastly, we describe the dermatological data available for the new, recently FDA-and EMA- approved, solvent-free nab-paclitaxel.

New Oral Formulation and in Vitro Evaluation of Docetaxel-Loaded Nanomicelles

Intravenous administration of Taxotere^® (a commercial form of docetaxel, DTX) leads to many problems such as hypersensitivity, hemolysis, cutaneous allergy, and patient refusal due to its prolonged injection. The oral absorption of DTX is very low due to its hydrophobic nature. The purpose of this study was to prepare and carry out an in vitro evaluation of DTX-loaded nanomicelles for oral administration in order to increase the oral delivery of DTX. Studied formulations were prepared with the two surfactants Tween 20 and Tween 80 and were characterized for their particle size, zeta potential, stability, encapsulation efficiency, stability studies in gastric fluid and intestinal fluid, toxicity studies in C26 colon carcinoma cell line, and cellular uptake. The prepared nanomicelles with particle size of around 14 nm and encapsulation efficiency of 99% were stable in gastric fluid and intestinal fluid for at least 6 h and IC50 decreased significantly after 72 h exposure compared to that of Taxotere^®. Nanomicelles increased the water solubility of DTX more than 1500 times (10 mg/mL in nanomicelles compared to 6 µg/mL in water). Results of this study reveal that the new formulation of DTX could be used for the oral delivery of DTX and merits further investigation.

Pharmacokinetics, dynamics and toxicity of docetaxel: Why the Japanese dose differs from the Western dose

Docetaxel (Taxotere®) has been one of the most important chemotherapeutic drugs for cancer treatment since 1996. Although a large number of clinical studies have been conducted in various cancer fields, there is a discrepancy in the standard dose between Japan and Western countries. This article reviews the pharmacokinetic, pharmacodynamic and toxicological profiles of docetaxel, and explains why there exists an ethnic difference in dose, and further discusses which direction we should go forward to solve this problem. The original recommended dose was 100 mg/m² every 3 weeks in US and European populations, while a Japanese phase I study suggested the recommended dose as 60 mg/m² every 3 weeks. A prospective population pharmacokinetic analysis of docetaxel conducted in both the USA/Europe and Japan, indicated an absence of ethnic difference in the pharmacokinetics. Both analyses demonstrated that docetaxel clearance is related to α1-acid glycoprotein level, hepatic function, age and body surface area. The relationship was observed between increasing docetaxel dose and increased tumor response rates across the dose range of 60 to 100 mg/m². The area under the serum concentration time curve (AUC) of docetaxel at the first cycle was significantly related to time to progression. Hematological toxicities were well correlated with the AUC of docetaxel, and severe hematological toxicities were more frequently observed in Japanese patients treated with 60 mg/m², compared to the US/European patients treated with 75–100 mg/m² dose. The Japanese population seems more susceptible to the toxicity of docetaxel. A docetaxel dose of 75 mg/m² is now standard not only in global trials but also in recent Japanese trials. Although the optimal dose of docetaxel is still unclear, we need to continue to seek the appropriate dose of docetaxel depending on patient status and the goals of chemotherapy.

Comparison of patient reported quality of life and impact of treatment side effects experienced with a taxane-containing regimen and standard anthracycline based chemotherapy for early breast cancer: 6 year results from the UK TACT trial (CRUK/01/001)

BACKGROUND

The TACT trial (CRUK/01/001) compared adjuvant sequential FEC-docetaxel (FEC-D) chemotherapy with standard anthracycline-based chemotherapy of similar duration in women with early breast cancer. Results at a median of 5 years suggested no improvement in disease-free survival with FEC-D. Given differing toxicity profiles of the regimens, the impact on quality of life (QL) was explored.

METHODS

Patients from 44 centres completed standardised QL questionnaires before chemotherapy, after cycles 4 and 8, at 9, 12, 18 and 24 months and at 6 years follow-up. Patient diaries assessed frequency, associated distress and impact on daily activity of 15 treatment related side effects.

FINDINGS

830 patients (415 FEC-D; 415 controls) contributed assessments during 0-24 months; 362 of whom participated again at 6 years. During chemotherapy, FEC-D impaired global health/QL and depression rates and significantly more QL domains than standard regimens. Novel diary card ratings highlighted significantly more distress and interference with daily activities due to FEC-D side effects compared with standard treatment. In both groups, most QL parameters returned to baseline levels by 2 years and were unchanged at 6 years.

INTERPRETATION

Within expected negative effects of chemotherapy on wide ranging QL domains FEC-D patients reported greater toxicity, disruption and distress during treatment with no improvement in disease outcome at 5 years than patients receiving standard anthracycline-based chemotherapy. Findings should inform future patients of relative costs and benefits of adjuvant chemotherapy.

Chemotherapy-induced hand-foot syndrome and nail changes: a review of clinical presentation, etiology, pathogenesis, and management

Chemotherapy-induced hand-foot syndrome and nail changes are common complications of many classic chemotherapeutic agents and the newer molecular targeted therapies. They significantly impact patient quality of life, and frequently necessitate chemotherapy dose intensity modification or reduction. We aim to describe the epidemiology, pathogenesis, clinical presentation, and current evidence-based treatment options for these entities.

Health-related quality of life in patients with nail disorders

Fingernails and toenails are important organs of our body, serving as protection for the tips of fingers and toes. Fingernails also enhance fine touching and tactile sensitivity, as well as aid in the picking up of small objects. Healthy-looking nails are an important part of an individual's body image, and any nail abnormalities may be considered by patients as a significant cosmetic problem, markedly influencing their self-esteem. However, recent data have indicated that nail lesions are not only important because of cosmetic disfigurement, but may be a symptom of significant morbidity. Severe nail involvement was also shown to negatively impair social functioning and to interfere with work ability, thus markedly influencing a patient's well-being. Based on literature data and our own experience we conclude that nail diseases cause a marked decrease in health-related quality of life in a substantial percentage of patients. Nail changes are an important medical concern for patients and, therefore, nail diseases should raise attention and receive proper care from both physicians and other healthcare providers.

Docetaxel-related side effects and their management

Docetaxel is an effective treatment approved in five key cancers, but its effectiveness in clinical practice can be compromised by sub-optimal side-effect management. The aim of this review was to investigate the extent of the published work on specific docetaxel-related side effects and to provide, where possible, evidence-based recommendations for their prevention and management. PubMed and the American Society of Clinical Oncology (ASCO) databases were systematically searched for articles published in English over the past 5 years and 2 years, respectively, and pertaining to six side effects identified as being common to the majority of docetaxel regimens and indications and of particular relevance to the oncology nurse. The Cochrane library was also searched. A total of 103 citations were identified, 14 of which discussed strategies for the prevention or management of febrile neutropenia (n=6), hypersensitivity reactions (3), fluid retention (1) and nail changes (4). No articles were identified that related to asthenia or neuropathy. Based on the literature review, evidence/guidelines-based advice for the use of G-CSF in febrile neutropenia is provided. The evidence base with respect to the other side effects does not permit the formulation of recommendations. It is the experience of the authors, however, that the severity of symptoms experienced by patients is generally mild and the side effects are for the most part easily managed with prophylactic and supportive care measures. It is, therefore, important to share and build on experiences, through research and discussion, to maximise the healthcare professional's ability to offer the best standard of care to patients.

Nail Toxicity Induced by Cancer Chemotherapy

Purpose. To provide a comprehensive literature review of chemotherapy-induced nail toxicity, including clinical presentation, implicated drugs and approaches for prevention and management.

Data sources. A search of MEDLINE and EMBASE (1966—2008) databases was conducted using the terms (and variations of the terms) antineoplastic agents, nails, nail toxicity, onycholysis, and paronychia. Bibliographies from selected articles were reviewed for appropriate references.

Data extraction. The retrieved literature was reviewed to include all articles relevant to the clinical presentation, diagnosis, incidence, prevention, and treatment of chemotherapy-induced nail toxicity.

Data synthesis. Nail toxicity is a relatively uncommon adverse effect linked to a number of chemotherapeutic agents. Clinical presentation varies, depending on which nail structure is affected and the severity of the insult. Nail changes may involve all or some nails. Toxicity may be asymptomatic and limited to cosmetic concerns, however, more severe effects, involving pain and discomfort can occur. Taxanes and anthracyclines are the antineoplastic drug groups most commonly implicated. It is suggested that the administration schedule may influence the incidence of nail abnormalities, for example reported cases linked to the weekly administration of paclitaxel.

Before instituting chemotherapy, patients should be educated regarding potential nail toxicities and strategies for prevention implemented. Management includes appropriate nail cutting, avoiding potential irritants, topical, or oral antimicrobials, and possibly cessation or dose reduction of the offending agent. Cryotherapy, through the application of frozen gloves or socks, has been beneficial in reducing docetaxel-induced nail toxicity and may be effective for other drugs. J Oncol Pharm Practice (2009) 15: 143—155.

Matched case-control phase 2 study to evaluate the use of a frozen sock to prevent docetaxel-induced onycholysis and cutaneous toxicity of the foot

BACKGROUND

Onycholysis occurs in approximately 30% of patients treated with docetaxel. The efficacy and safety of an Elasto-Gel frozen sock (FS) was investigated for the prevention of docetaxel-induced nail and skin toxicity of the feet.

METHODS

Patients receiving docetaxel at a dose of 70 to 100 mg/m(2) every 3 weeks were eligible for this matched case-control study. Each patient wore an FS for 90 minutes on the right foot. The unprotected left foot acted as control. Nail and skin toxicities were assessed using National Cancer Institute Common Toxicity Criteria (version 3) and compared using a 2-sample Wilcoxon matched-pairs rank test adjusted for tied values.

RESULTS

Fifty consecutive patients were included between April 2005 and January 2007. Nail toxicity was significantly lower in the FS-protected foot compared with the control foot (grade 0: 100% versus 79%; and grade 1 and 2: 0% versus 21%, respectively) (P= .002). Skin toxicity was grade 0: 98% versus 94%; and grade 1 and 2: 2% versus 6% in the FS-protected and the control feet, respectively. The median times until toxicity occurrence were not found to differ significantly between the groups. One patient experienced discomfort because of cold intolerance.

CONCLUSIONS

Cold therapy using FS significantly reduced the incidence of docetaxel-induced foot nail toxicity, as previously demonstrated using frozen gloves for the hands.