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Daher R, Ruplin A, Gupta S, Spiess PE, Kamat AM, Cigliola A, Tateo V, Mercinelli C, Grivas P, Necchi A. The spectrum of cutaneous toxicities related to novel genitourinary cancer therapies. Crit Rev Oncol Hematol 2024; 200:104420. [PMID: 38906514 DOI: 10.1016/j.critrevonc.2024.104420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/29/2024] [Accepted: 06/07/2024] [Indexed: 06/23/2024] Open
Abstract
CONTEXT Genitourinary cancers (GUCs) encompass malignancies affecting the urinary and reproductive systems, including renal cell carcinoma (RCC), urothelial carcinoma (UC), and prostate cancer (PC). With the rapidly evolving therapeutic domain of these cancers, cutaneous adverse events (AEs) remain among the most observed toxicities. OBJECTIVE To explore the dermatologic AEs linked to novel GUC treatments, their underlying pathophysiology, clinical presentations, and risk factors. EVIDENCE ACQUISITION A narrative review of the literature from PubMed and Embase databases was conducted. The search strategy included dermatologic/cutaneous adverse events, risk factors, and pathophysiology in conjunction with the following classes of therapies; immune checkpoint inhibitors (ICIs), antiangiogenic therapies, enfortumab vedotin (EV), erdafitinib, and androgen receptor antagonists (ARAs). EVIDENCE SYNTHESIS Maculopapular rash, pruritus, and alopecia are present among the five classes of therapies. ICIs demonstrate the highest incidence of severe drug AEs including Steven Johnson syndrome/toxic epidermal necrolysis. Unique cutaneous AEs present with specific therapies including hand-foot skin reaction and subungual splinter hemorrhage with antiangiogenic drugs, stomatitis/mucositis and onycholysis with erdafitinib. Incidence and type of cutaneous AE also differed within therapies in the same class as seen with apalutamide displaying the highest risk of cutaneous AEs within ARAs. Risk factors for development of cutaneous AEs can be general to therapies, or specific, and include age, immune status, BMI, and gender. CONCLUSIONS Dermatologic AEs may impact patients' quality of life and increase the tendency to dose reduce, hold or discontinue life-saving therapies, underscoring the need for vigilant monitoring, early recognition, and collaborative management between medical oncologists, pharmacists, dermatologists and other specialists.
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Affiliation(s)
- Rachel Daher
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Andrew Ruplin
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Shilpa Gupta
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Antonio Cigliola
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valentina Tateo
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Mercinelli
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Petros Grivas
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Andrea Necchi
- Vita-Salute San Raffaele University, Milan, Italy; Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
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Tahara Y, Amemiya A, Kase R, Kitagawa Y, Ogasawara S, Kato N, Komiyama M. Relationship between hand-foot skin reaction and external force on patients with hepatocellular carcinoma: A cohort study. Eur J Oncol Nurs 2024; 70:102576. [PMID: 38642523 DOI: 10.1016/j.ejon.2024.102576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/17/2024] [Accepted: 03/20/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE Hand-foot skin reaction (HFSR), a side effect of tyrosine kinase inhibitor (TKI) treatment, makes it difficult to walk and perform daily activities because of pain in the limbs. HFSR occurs predominantly in the sites where external forces (pressure and shear stress) are applied. This study aimed to determine whether pressure or shear stress induces the occurrence of HFSR. METHODS This cohort study was conducted in patients who received TKI treatment for hepatocellular carcinoma. The external forces applied to the sole of the patients' foot while walking was measured, and its association with the occurrence of HFSR was examined. The degree of HFSR was assessed by the patient's response during the examination and by photographs of their feet. The patients' feet were divided into low (grade <2) or high (grade ≥2) HFSR foot group, and the differences in external forces between the groups were analyzed using t-test and Cox hazard analysis. RESULTS Analysis of the feet of 55 study participants (n = 110) showed no significant difference between the groups on t-test (p ≥ 0.05), however, Cox hazard analysis showed an increased risk of HFSR with higher peak shear stress values at the fifth metatarsal head (hazard ratio = 1.01, p = 0.047; 95% confidence interval = 1.00-1.02). CONCLUSION Shear stress is possibly related to HFSR occurrence. Nurses should assess whether patients' shoes fit their feet before initiating TKI treatment. They should instruct patients to wear shoes that are fit of both diameter and width for their feet.
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Affiliation(s)
- Yukie Tahara
- Department of Health Promotion in Nursing and Midwifery, Graduate School of Nursing, Chiba University, Chiba, Japan.
| | - Ayumi Amemiya
- Department of Health Promotion in Nursing and Midwifery, Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Ryutaro Kase
- Department of Health Promotion in Nursing and Midwifery, Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Yuka Kitagawa
- Department of Health Promotion in Nursing and Midwifery, Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masatoshi Komiyama
- Department of Health Promotion in Nursing and Midwifery, Graduate School of Nursing, Chiba University, Chiba, Japan
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Garg V, Gangadharaiah BB, Rastogi S, Upadhyay A, Barwad A, Dhamija E, Gamangatti S. Efficacy and tolerability of sorafenib in desmoid-type fibromatosis: A need to review dose. Eur J Cancer 2023; 186:142-150. [PMID: 37062211 DOI: 10.1016/j.ejca.2023.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Sorafenib is currently one of the recommended treatments for symptomatic patients with desmoid-type fibromatosis (DTF). In this study, we aim to assess the clinical efficacy and tolerability of sorafenib in DTF patients. METHODOLOGY Patients aged>18 years with a histological diagnosis of DTF and who have received sorafenib were enroled in this prospective observational study. Demographic data, clinical profile, the initial dose of sorafenib, treatment-related toxicities, dose modifications, and responses were recorded. The primary objective was to assess the objective response rate (ORR). The secondary objectives were to evaluate progression-free survival (PFS), tolerability, and adverse effects of sorafenib. Response assessment was based on response evaluation criteria in solid tumours 1.1 criteria. Adverse effects were graded according to National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 criteria. Time to event was calculated by Kaplan-Meier analysis, and survival was compared by log-rank test. Univariate and multivariable cox regression analysis were used to find independent predictors of relapse. RESULTS A total of 104 patients were enroled in the study. The median age of the study population was 32 (range, 18-81) years, and 66.35% of patients were females. On response assessment, ORR was 46.1% and stable disease was observed in 31.7% patients. ORR was higher in the appendicular site (51.7%) compared to the abdominal site (27.2%). PFS at 1 and 2 years was 86.6% (79.6-92.7%) and 73.7% (62.4-82.8%), respectively. Two-thirds (66.6%) of patients had already received some form of treatment. At the time of analysis, 70 (67.3%) patients were continuing sorafenib. Only 4.8% stopped sorafenib due to progression, 10.5% due to intolerable adverse effects, and 17.3% due to other reasons. The common treatment-related toxicities were hand-foot skin reaction (HFSR) (89.4%), fatigue (79.8%), alopecia (70.1%), and diarrhoea (48.0%). In the patients with a starting dose of ≥400 mg (48.0% of patients), discontinuation was necessitated in 12% of patients, and further dose reduction was required in 58%, while only about 13% required dose reduction or discontinuation at a starting dose of 200 mg (51.9% of patients). Responses were not compromised due to lower starting doses. CONCLUSIONS Sorafenib has good activity in DTF, but it is associated with significant toxicity. The adverse effect profile is distinct in Indian patients with higher HFSR and alopecia. Due to the high rate of dose reduction/discontinuation with a starting dose of 400 mg, a starting dose of 200 mg may be recommended in Indian patients.
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Affiliation(s)
- Vikas Garg
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India.
| | | | - Sameer Rastogi
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India.
| | | | | | - Ekta Dhamija
- Department of Radiodiagnosis, BRAIRCH, AIIMS, Delhi, India.
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Zengin ZB, Pal SK, McDermott DF, Escudier B, Hutson TE, Porta C, Verzoni E, Atkins MB, Kasturi V, Rini B. Temporal Characteristics of Adverse Events of Tivozanib and Sorafenib in Previously Treated Kidney Cancer. Clin Genitourin Cancer 2022; 20:553-557. [PMID: 36096984 DOI: 10.1016/j.clgc.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Tivozanib, vascular endothelial growth factor receptor inhibitor, met the primary endpoint of improved progression free survival compared to sorafenib in the phase 3 TIVO-3 study in patients with previously treated metastatic renal cell carcinoma. In this study we sought to understand the temporal characteristics of treatment related adverse events (TRAEs) and frequency and timing of the dose modifications. MATERIALS AND METHODS In this open label, randomized, phase 3 TIVO-3 study, previously treated patients with a diagnosis of metastatic renal cell carcinoma and with measurable disease were included. Patients were randomized to receive either tivozanib 1.5 mg orally once daily in 4-week cycles or sorafenib 400 mg orally twice daily continuously. Based on updated safety analysis data (cutoff date of August 15, 2019), time to onset of the most commonly reported TRAEs, duration of toxicity, rate of dose modifications was calculated for each treatment arm. RESULTS Overall, 350 patients were randomly assigned to receive tivozanib or sorafenib;173 patients from the tivozanib arm and 170 patients from the sorafenib arm were included in this analysis. Patients received a median of 11.9 cycles (336 days) and 6.7 cycles (192 days) of tivozanib and sorafenib, respectively. Dose reductions, interruptions and treatment discontinuations were 25%, 50%, and 21%, and 39%, 50%, and 30% in the tivozanib and sorafenib arms, respectively, with a longer time to onset of TRAEs in the tivozanib arm. CONCLUSION Tivozanib was associated with less TRAEs, fewer dose modifications, a longer time to onset and a shorter duration of TRAEs compared to sorafenib.
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Affiliation(s)
- Zeynep B Zengin
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sumanta K Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - David F McDermott
- Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA
| | | | | | - Camillo Porta
- Division of Medical Oncology, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Elena Verzoni
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Brian Rini
- Vanderbilt-Ingram Cancer Center, Nashville, TN.
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Hasan Alshammari A, Masuo Y, Fujita KI, Shimada K, Iida N, Wakayama T, Kato Y. Discrimination of hand-foot skin reaction caused by tyrosine kinase inhibitors based on direct keratinocyte toxicity and vascular endothelial growth factor receptor-2 inhibition. Biochem Pharmacol 2022; 197:114914. [PMID: 35041812 DOI: 10.1016/j.bcp.2022.114914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/19/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) are molecular-targeted anticancer drugs. Their benefits are limited by dermal toxicities, including hand-foot skin reaction (HFSR), which is commonly found in skin areas subjected to friction. The present study aimed to explain the incidence of HFSR in patients treated with TKIs by focusing on keratinocyte toxicity and inhibition of vascular endothelial growth factor receptor (VEGFR), which plays an essential role in angiogenesis. Mice with gene knockout for the immunosuppressive cytokine interleukin-10 exhibited HFSR-like phenotypes, such as cytotoxicity in keratinocytes and increased number and size of blood vessels after repeated doses of regorafenib, sorafenib, and pazopanib, all of which cause high incidence of HFSR, in combination with tape-stripping mimicking skin damage at the friction site. Comprehensive examination of the direct cytotoxic effects of 21 TKIs on primary cultured human keratinocytes revealed that 18 of them reduced the cell viability dose-dependently. Importantly, the ratio of the trough concentration in patients (Ctrough) to the LC50 values of cell viability reduction was higher than unity for four HFSR-inducing TKIs, suggesting that these TKIs cause keratinocyte toxicity at clinically relevant concentrations. In addition, eight HFSR-inducing TKIs caused inhibition of VEGFR-2 kinase activity, which was validated by their ratios of Ctrough to the obtained IC50,VEGFR-2 of more than unity. All 12 TKIs with no reported incidence of HFSR exhibited less than unity values for both Ctrough/LC50,keratinocytes and Ctrough/IC50,VEGFR-2. These results suggested that a combination of keratinocyte toxicity and VEGFR-2 inhibition may explain the incidence of HFSR upon TKI usage in humans.
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Affiliation(s)
- Aya Hasan Alshammari
- Faculty of Pharmacy, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan
| | - Yusuke Masuo
- Faculty of Pharmacy, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan
| | - Ken-Ichi Fujita
- Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Kazuhiro Shimada
- Faculty of Pharmacy, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan
| | - Noriho Iida
- Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa 920-8641, Japan
| | - Tomohiko Wakayama
- Department of Histology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yukio Kato
- Faculty of Pharmacy, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan.
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Ceglio WQGW, Rebeis MM, Santana MF, Miyashiro D, Cury-Martins J, Sanches JA. Cutaneous adverse events to systemic antineoplastic therapies: a retrospective study in a public oncologic hospital. An Bras Dermatol 2021; 97:14-21. [PMID: 34844792 PMCID: PMC8799855 DOI: 10.1016/j.abd.2021.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Mucocutaneous adverse events are common during anticancer treatment, with variable consequences for the patient and their therapeutic regimen. Objective To evaluate the most common adverse events, as well as the drugs associated with their appearance and the consequences for cancer treatment. Methods A retrospective study was carried out through the analysis of patients treated at the Clinical Dermatology Unit of a public oncologic hospital. Results A total of 138 patients with 200 adverse events were evaluated. The most commonly identified adverse events were nail and periungual changes (20%), papulopustular eruptions (13%), acneiform eruptions (12%), hand-foot syndrome (6.5%), hand-foot skin reaction (6%), and xerosis (6%). The most frequently associated antineoplastic treatment groups were classical chemotherapy (46.2%), target therapy (32.3%), and other non-antineoplastic drugs used in neoplasia protocols (16.5%). Of the total number of patients, 17.4% had their treatment suspended or changed due to a dermatological adverse event. Study limitations Retrospective study and analysis of patients who were referred for specialized dermatological examination only, not allowing the assessment of the actual incidence of adverse events. Conclusion A wide variety of dermatological manifestations are secondary to antineoplastic treatment with several different drugs resulting, not rarely, in the interruption or modification of therapeutic regimens.
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Affiliation(s)
| | - Marina Mattos Rebeis
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcela Ferreira Santana
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Denis Miyashiro
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jade Cury-Martins
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - José Antônio Sanches
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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Wu TC, Shen YC, Cheng AL. Evolution of systemic treatment for advanced hepatocellular carcinoma. Kaohsiung J Med Sci 2021; 37:643-653. [PMID: 34213069 DOI: 10.1002/kjm2.12401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022] Open
Abstract
Advanced hepatocellular carcinoma (HCC) was considered an inherently refractory tumor in the chemotherapy era (1950-2000). However, systemic therapy has evolved to molecular targeted therapy and immunotherapy, and nine treatment regimens have been approved worldwide during the past 20 years. The approved regimens target tumor angiogenesis or tumor immunity, the two cancer hallmarks. Recently, the combination of atezolizumab (antiprogrammed cell death ligand 1) and bevacizumab (anti-vascular endothelial growth factor) has improved the efficacy of systemic therapy in treating advanced HCC without excessive toxicities or deterioration of quality of life. This review summarizes the major advances in systemic therapy and provides future perspectives on the next-generation systemic therapy for advanced HCC.
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Affiliation(s)
- Tsung-Che Wu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Chun Shen
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.,Graduate Institute of Oncology, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.,Graduate Institute of Oncology, School of Medicine, National Taiwan University, Taipei, Taiwan
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Hyperkeratotic Skin Adverse Events Induced by Anticancer Treatments: A Comprehensive Review. Drug Saf 2021; 43:395-408. [PMID: 31981081 DOI: 10.1007/s40264-020-00907-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hyperkeratotic skin adverse events are a group of toxic effects, characterized by the disruption of epidermal homeostasis and interaction with keratinocyte proliferation/differentiation or keratinocyte survival, and frequently reported with systemic anticancer treatments. These types of reactions include hand-foot skin reaction or palmoplantar keratoderma, induced psoriasis, keratosis pilaris-like or pityriasis rubra pilaris-like rashes, Grover's disease, and contact hyperkeratosis. Cutaneous squamoproliferative lesions are also described because of the presence of abnormal keratinocyte proliferation. They are usually observed with tyrosine kinase inhibitors but have also been described in association with cytotoxic chemotherapeutic agents. Their pathogenesis is related mainly to the disruption of epidermal homeostasis and interaction with keratinocyte proliferation/differentiation or keratinocyte survival caused by anticancer treatment. Early recognition and adequate management are critical to prevent exacerbation of the lesions, to limit treatment interruption, and to minimize impairment of quality of life. This review summarizes the current knowledge concerning the presentation, pathogenesis, and management of secondary hyperkeratotic reactions to anticancer therapies. It also includes hyperkeratotic reactions that have been more recently described with newly approved targeted therapies or immune checkpoint inhibitors, such as keratosis pilaris-like exanthema with second-generation BCR-ABL inhibitors, lamellar ichthyosis-like lesions with ponatinib, pityriasis rubra pilaris with the newly approved selective phosphoinositide 3 kinase inhibitor idelalisib, or psoriasis with anti-programmed death-1 and programmed death ligand-1.
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Chen J, Wang Z. How to conduct integrated pharmaceutical care for patients with hand-foot syndrome associated with chemotherapeutic agents and targeted drugs. J Oncol Pharm Pract 2021; 27:919-929. [PMID: 33874817 DOI: 10.1177/10781552211009291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this article was to offer practical operational process for pharmacists to successfully conduct integrated pharmaceutical care for patients with hand-foot syndrome associated with chemotherapeutic agents and targeted drugs which may facilitate the work of first-line clinical pharmacist.Data sources: A literature review was conducted in March 2020 of Pubmed, Medline, and EMBASE (2010-2020) using terms such as: hand-foot syndrome, hand-foot skin reaction, palmar-plantar erythrodysesthesia, chemotherapeutic agent, and multikinase inhibitor. Appropriate references from selected articles were also used.Data summary: This paper involves 81 articles including review articles, meta-analysis, and clinical trials which focused on every aspect of hand-foot syndrome, such as manifestation, mechanism, occurrence rate, onset time, patient education, self-monitor scale, and management. Studies were thematically divided into four parts (clinical presentation of HFS, risk stratification, initiation of pharmaceutic care, and management of the adverse reaction). CONCLUSION HFS is one of the common adverse events which was associated with many chemotherapeutic agents and multikinase inhibitor drugs. Although the mechanisms and histopathology may be different, they due share some common clinical manifestations. As part of integrated pharmaceutical care for cancer patients, it is important to conduct patient education about the risk of hand-foot syndrome and basic knowledge about hand-foot syndrome management before initiating anticancer therapy. Once hand-foot syndrome happens, evidence-based management could try. If the hand-foot syndrome is intolerable, dose reduction or discontinuation of the anticancer therapy should be considered.
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Affiliation(s)
- Jiexiu Chen
- Department of Pharmacy, Sichuan Provincial Women's and Children's Hospital, Chengdu, China
| | - Zhuo Wang
- Department of Pharmacy, Changhai Hospital of Shanghai, Shanghai, China
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Synthesis and Characterization of Chitosan-Based Nanodelivery Systems to Enhance the Anticancer Effect of Sorafenib Drug in Hepatocellular Carcinoma and Colorectal Adenocarcinoma Cells. NANOMATERIALS 2021; 11:nano11020497. [PMID: 33669332 PMCID: PMC7920308 DOI: 10.3390/nano11020497] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 12/15/2022]
Abstract
The formation of two nanodelivery systems, Sorafenib (SF)-loaded chitosan (SF-CS) and their folate-coated (SF-CS-FA) nanoparticles (NPs), were developed to enhance SF drug delivery on human Hepatocellular Carcinoma (HepG2) and Colorectal Adenocarcinoma (HT29) cell lines. The ionic gelation method was adopted to synthesize the NPs. The characterizations were performed by DLS, FESEM, TEM, XRD, TGA, FTIR, and UV-visible spectroscopy. It was found that 83.7 ± 2.4% and 87.9 ± 1.1% of encapsulation efficiency; 18.2 ± 1.3% and 19.9 ± 1.4% of loading content; 76.3 ± 13.7 nm and 81.6 ± 12.9 nm of hydrodynamic size; 60–80 nm and 70–100 nm of TEM; and FESEM sizes of near-spherical shape were observed, respectively, for SF-CS and SF-CS-FA nanoparticles. The SF showed excellent release from the nanoparticles under pH 4.8 PBS solution, indicating a good delivery system for tumor cells. The cytotoxicity study revealed their better anticancer action towards HepG2 and HT29 cell lines compared to the free sorafenib. Moreover, both NPs systems showed negligible toxicity to normal Human Dermal Fibroblast adult cells (HDFa). This is towards an enhanced anticancer drug delivery system with sustained-release properties for better cancer management.
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Shou L, Shao T, Zhao F, Chen S, Chen Q, Shu Q. The Efficacy and Safety of the Shouzu Ning Decoction Treatment for Multi-Kinase Inhibitors-Associated Severe Hand-Foot Skin Reaction. Cancer Manag Res 2021; 13:45-53. [PMID: 33442293 PMCID: PMC7800444 DOI: 10.2147/cmar.s285002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background Multi-kinase inhibitors (MKIs) treatment plays an important role in cancer therapy, but still suffers from a high incidence of hand–foot skin reaction (HFSR), leading to MKIs dose modification or termination. Thus, there is a high need for therapeutic strategy for HFSR. Patients and Methods This prospective analysis included twenty patients, who were continuously administered with MKIs treatment and presented with a grade 3 HFSR during January 2018 to December 2019. All the patients were treated with the Shouzu Ning Decoction (SND) twice a day, in addition to the MKIs treatment. Grading of HFSR was assessed by National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. Pain intensity was evaluated using the numerical rating scale (NRS). Quality of life was assessed using the Hand–Foot Quality of Life Scale (HF-QoLS). Results The median time from MKIs initiation to onset of grade 3 HFSR was 26.2 days. Following the SND treatment, seventeen (17/20) patients displayed grade 2 HFSR with a median time of 5.1 days. Among whom, seven (7/17) finally transformed to grade 1 with a median time of 9.9 days. While all of the grade 1 patients (7/7) had local recurrence, and retreatment of the SND was effective. In addition, after the SND treatment, the score of NRS and HF-QoLS decreased to 1.60 ± 1.14 (P < 0.01) and 26.75 ± 11.76 (P < 0.01), respectively. Conclusion The SND treatment could alleviate symptoms, relieve pain and improve quality of life in HFSR patients. The SND treatment was proved to be an effective and well-tolerated treatment for MKIs-associated grade 3 HFSR patients for the first time. Indeed, further randomized controlled trails with large-scale, multi-center are require to fully determine the clinical application of the SND in MKIs-associated HFSR.
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Affiliation(s)
- Liumei Shou
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China.,The First Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Tianyu Shao
- The First Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Fangmin Zhao
- The First Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Shuyi Chen
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Qunwei Chen
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Qijin Shu
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
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Winters AC, Bedier F, Saab S. Management of Side Effects of Systemic Therapies for Hepatocellular Carcinoma: Guide for the Hepatologist. Clin Liver Dis 2020; 24:755-769. [PMID: 33012457 DOI: 10.1016/j.cld.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Historically, systemic treatment of advanced hepatocellular carcinoma was limited to the tyrosine kinase inhibitor sorafenib. With the recent approval of several new agents the armamentarium of treatment options available to providers and patients has expanded. Although these promising advances offer hope for patients with advanced hepatocellular carcinoma, they also present new and challenging adverse effects that threaten to limit their efficacy. Immunotherapy with checkpoint inhibitors introduce immune-related adverse events, which may affect a wide array of organ systems. With prompt recognition, however, common side effects of systemic therapies for hepatocellular carcinoma are predictable, manageable, and many improve with appropriate intervention.
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Affiliation(s)
- Adam C Winters
- Pfleger Liver Institute, 200 Medical Plaza Driveway, Suite 214, Los Angeles, CA 90095, USA
| | - Fatima Bedier
- Pfleger Liver Institute, 200 Medical Plaza Driveway, Suite 214, Los Angeles, CA 90095, USA
| | - Sammy Saab
- Pfleger Liver Institute, 200 Medical Plaza Driveway, Suite 214, Los Angeles, CA 90095, USA.
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Effect of urea cream on sorafenib-associated hand-foot skin reaction in patients with hepatocellular carcinoma: A multicenter, randomised, double-blind controlled study. Eur J Cancer 2020; 140:19-27. [PMID: 33039810 DOI: 10.1016/j.ejca.2020.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hand-foot skin reaction (HFSR) is the most common adverse event during sorafenib treatment in patients with hepatocellular carcinoma (HCC). In the present study, we aimed to investigate the role of urea cream in the prevention of HFSR or amelioration of HFSR severity. PATIENTS AND METHODS Patients with HCC were treated with either placebo cream or urea cream for 12 weeks concomitantly with sorafenib treatment. HFSR development, the Hand-Foot Skin Reaction and Quality of Life (HF-QoL) questionnaire score, and adverse events were assessed at 2, 4, 8 and 12 weeks. RESULTS Of the 288 patients, 247 patients, with 117 patients in the placebo control group and 130 patients in the urea cream group, were analysed. The urea cream group showed a trend towards a lower cumulative incidence of any-grade HFSR (log-rank, P = 0.247) and severe HFSR of grade II or higher (log-rank, P = 0.394) without statistical significance. In the incidence by time point, the incidence of severe HFSR of grade II or higher was significantly lower in the urea cream group than in the placebo control group at 2 weeks (13.8% versus 23.9%, P = 0.042). The urea cream group showed a significantly better HF-QoL questionnaire score than the placebo control group (11.8 versus 19.7, P = 0.014) at 12 weeks. CONCLUSIONS Treatment with urea cream showed a lower incidence of severe sorafenib-induced HFSR at 2 weeks and reduced the tendency of HFSR development in HCC patients. Therefore, treatment with urea cream may be considered for prophylaxis or improvement of HFSR grade in HCC patients treated with sorafenib. TRIAL REGISTRATION ClinicalTrials.gov (NCT03212625).
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Williams LA, Ginex PK, Ebanks GL, Ganstwig K, Ciccolini K, Kwong BK, Robison J, Shelton G, Strelo J, Wiley K, Maloney C, Moriarty KA, Vrabel M, Morgan RL. ONS Guidelines™ for Cancer Treatment-Related Skin Toxicity. Oncol Nurs Forum 2020; 47:539-556. [PMID: 32830806 DOI: 10.1188/20.onf.539-556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Management of cancer treatment-related skin toxicities can minimize treatment disruptions and improve patient well-being. OBJECTIVES This guideline aims to support patients and clinicians in decisions regarding management of cancer treatment-related skin toxicities. METHODS A panel developed a guideline for management of cancer treatment-related skin toxicities using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) for certainty of evidence and the National Academies of Sciences, Engineering, and Medicine criteria for trustworthy guidelines. The Cochrane risk-of-bias tool assessed risk of bias. A quantitative or narrative synthesis of the evidence was completed. RESULTS The panel issued seven conditional recommendations for epidermal growth factor receptor inhibitor rash, hand-foot skin reaction, hand-foot syndrome, and chemotherapy-induced alopecia. The panel suggested strategies for prevention and treatment for all toxicities except hand-foot syndrome, which only has a prevention recommendation. IMPLICATIONS FOR NURSING Cancer treatment-related skin toxicities can significantly affect quality of life. Incorporation of these interventions into clinical care can improve patient outcomes. SUPPLEMENTARY MATERIAL CAN BE FOUND AT&NBSP;HTTPS //onf.ons.org/supplementary-material-ons-guidelines-cancer-treatment-related-skin-toxicity.
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15
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Chiorean EG, Perkins SM, Strother RM, Younger A, Funke JM, Shahda SG, Hahn NM, Sandrasegaran K, Jones DR, Skaar TC, Schneider BP, Sweeney CJ, Matei DE. Phase I, Pharmacogenomic, Drug Interaction Study of Sorafenib and Bevacizumab in Combination with Paclitaxel in Patients with Advanced Refractory Solid Tumors. Mol Cancer Ther 2020; 19:2155-2162. [PMID: 32847973 DOI: 10.1158/1535-7163.mct-20-0277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/19/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022]
Abstract
VEGF blockade does not uniformly result in clinical benefit. We evaluated safety, dose-limiting toxicities (DLT), recommended phase II dose (RP2D), antitumor efficacy, and exploratory biomarkers including pharmacogenomics and pharmacokinetics with sorafenib, bevacizumab, and paclitaxel in patients with refractory cancers. The study had a "3 + 3" design, using paclitaxel 80 mg/m2 every week for 3 weeks, in every 4 week cycles, bevacizumab 5 mg/kg every 2 weeks, and sorafenib 200 or 400 mg twice a day, 5 or 7 days/week (5/7, 7/7). The MTD cohort was expanded. Twenty-seven patients enrolled in 3 cohorts: sorafenib 200 mg twice a day 5/7, 200 mg twice a day 7/7, and 400 mg twice a day 5/7. DLTs were grade 3 neutropenia >7 days (cohort 1, 1), grade 3 hypertension (cohort 2, 1), grade 3 hand-foot skin reaction (HFSR; cohort 3, 2). MTD was sorafenib 200 mg twice a day 7/7. Six DLTs occurred in cohort 2 expansion: grade 3 HFSR (2), grade 2 HFSR with sorafenib delay >7 days (2), grade 4 cerebrovascular accident (1), grade 3 neutropenia >7 days (1). RP2D was sorafenib 200 mg twice a day 5/7. Most patients (62%) dose reduced sorafenib to 200 mg daily 5/7 after a median 3 (range, 2-17) cycles. Response rates were 48% overall (27) and 64% for ovarian cancers (14). VEGF-A-1154AA and -7TT recessive homozygous genotypes conferred worse overall survival versus alternative genotypes (7 vs. 22 months). Intermittent, low-dose sorafenib (200 mg twice a day 5/7) combined with bevacizumab and paclitaxel was tolerable and had high antitumor efficacy in patients with refractory cancer (NCT00572078).
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Affiliation(s)
- E Gabriela Chiorean
- University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Susan M Perkins
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | | | - Anne Younger
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Jennifer M Funke
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Safi G Shahda
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Noah M Hahn
- Johns Hopkins University, Baltimore, Maryland
| | | | - David R Jones
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Todd C Skaar
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Bryan P Schneider
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
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Grothey A, Blay JY, Pavlakis N, Yoshino T, Bruix J. Evolving role of regorafenib for the treatment of advanced cancers. Cancer Treat Rev 2020; 86:101993. [DOI: 10.1016/j.ctrv.2020.101993] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 12/13/2022]
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17
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Nan X, Xie C, Zhu Q, Zhang J, Fu S, Han X, Zhang Q, Han B, Liu J. Hand-foot syndrome and survival in patients with advanced non-small-cell lung cancer receiving anlotinib: a subgroup analysis of data from the ALTER 0303 study. Int J Clin Oncol 2020; 25:1492-1498. [PMID: 32447474 DOI: 10.1007/s10147-020-01683-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The ALTER 0303 study showed that anlotinib can significantly improve overall survival (OS) compared with the placebo in advanced non-small-cell lung cancer (NSCLC). Hand-foot syndrome (HFS) is a common anlotinib-related adverse event. The aim of this study was to assess the association of HFS with clinical benefit. METHODS A subgroup analysis of patients treated with anlotinib from the ALTER 0303 study was performed. Our analysis assessed if the appearance of anlotinib-related HFS in the first 42 days (second-cycle HFS) and at any time could produce better clinical benefits. RESULTS In this study, 294 patients were treated with anlotinib. Of which, 129 patients had HFS at any time, and 76 patients developed HFS in the first 2 cycles. Patients who received anlotinib and developed HFS had significantly prolonged OS, progression-free survival (PFS) compared to those who did not develop HFS in the first 2 cycles (13.5 vs 8.7 months, p = 0.001; adjusted hazard ratio (HR) 0.63 (95% confidence interval [CI] 0.44-0.89), p = 0.009; 5.8 vs 4.5 months, p = 0.001; adjusted HR, 0.59 [0.43-0.81], p = 0.001). The significant OS and PFS benefits for patients with HFS versus without were seen at any time (14.5 vs 7.3 months, p = 0.000; adjusted HR, 0.50 [0.36-0.67], p = 0.000; 5.8 vs 4.2 months, p = 0.000; adjusted HR, 0.49 [0.37-0.65], p = 0.000). In addition, the grade of severity of HFS was strongly correlated with OS (p = 0.000). CONCLUSION Presence of HFS may be a potential clinical marker for the treatment of NSCLC with anlotinib.
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Affiliation(s)
- Xueli Nan
- Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China.,Department of Oncology, Wu Di People Hospital, Shandong, China
| | - Chao Xie
- Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China.,Department of Oncology, Shandong Cancer Hospital and Institute, Shandong, China
| | - Qingqing Zhu
- Department of Oncology, Shandong Cancer Hospital and Institute, Shandong, China.,School of Medicine and Life Sciences, University of Ji'nan-Shandong Academy of Medical Sciences, Shandong, China
| | - Jianjun Zhang
- Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China.,Department of Oncology, Shandong Cancer Hospital and Institute, Shandong, China
| | - Shuai Fu
- Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China.,Department of Oncology, Shandong Cancer Hospital and Institute, Shandong, China
| | - Xiao Han
- Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China.,Department of Oncology, Shandong Cancer Hospital and Institute, Shandong, China
| | - Qiujing Zhang
- Department of Oncology, Shandong Cancer Hospital and Institute, Shandong, China.,School of Medicine and Life Sciences, University of Ji'nan-Shandong Academy of Medical Sciences, Shandong, China
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai, China
| | - Jie Liu
- Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China. .,Department of Oncology, Shandong Cancer Hospital and Institute, Shandong, China.
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18
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Hartung B, Thiel W, Ritz-Timme S, Häussinger D, Erhardt A. Hand-foot syndrome induced changes of the palmar epidermal ridge configurations during and after treatment with capecitabine. Leg Med (Tokyo) 2020; 45:101710. [PMID: 32353749 DOI: 10.1016/j.legalmed.2020.101710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 12/29/2022]
Abstract
Palmar plantar erythrodysesthesia (hand-foot syndrome, HFS) is a common adverse event of treatment with cytostatic chemotherapeutics such as capecitabine. Histopathological findings are nonspecific and may even include generalized epidermal necrolysis. A total of 50 patients were examined before and after the intake of capecitabine to assess if HFS may result in relevant changes of the palmar epidermal ridge configurations with possible consequences for the patients who want to travel abroad. In total, 14 of the 50 patients developed HFS (28%) with HFS grades 1-3 observed. HFS grade 4 was not observed. HFS of grade 2 and 3 was associated with a temporary macroscopic loss of the epidermal ridges. No dactyloscopic changes that might have led to a false identification were seen in those cases. Patients with a risk of HFS development who want to travel abroad should carry a medical pass of the chemotherapeutic treatment to prevent them from difficulties in identification controls.
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Affiliation(s)
- Benno Hartung
- Institute of Legal Medicine, University Hospital Düsseldorf, Germany.
| | - Wolfgang Thiel
- University of Applied Sciences for Public Administration and Management Northrhine-Westphalia, Hagen, Germany
| | | | - Dieter Häussinger
- Department of Gastroenterology, Hepatology, and Infectious Dieseases, University Hospital Düsseldorf, Germany
| | - Andreas Erhardt
- Department of Gastroenterology, Hepatology, Diabetology, and Nutritional Medicine, Petrus Hospital Wuppertal, Germany
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19
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Ferreira MN, Ramseier JY, Leventhal JS. Dermatologic conditions in women receiving systemic cancer therapy. Int J Womens Dermatol 2019; 5:285-307. [PMID: 31909148 PMCID: PMC6938835 DOI: 10.1016/j.ijwd.2019.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/12/2019] [Accepted: 10/13/2019] [Indexed: 12/24/2022] Open
Abstract
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.
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20
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Ai L, Xu Z, Yang B, He Q, Luo P. Sorafenib-associated hand-foot skin reaction: practical advice on diagnosis, mechanism, prevention, and management. Expert Rev Clin Pharmacol 2019; 12:1121-1127. [PMID: 31679411 DOI: 10.1080/17512433.2019.1689122] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Sorafenib is a multitargeted tyrosine kinase inhibitor, which has been mainly used in the treatment of advanced hepatocellular carcinoma and renal cancer. However, hand-foot skin reaction (HFSR), as one of the most common adverse reactions, have hindered its long-term clinical application. At present, the mechanism of its occurrence has not been clearly studied and it leads to the lack of effective means of intervention. This article reviews known mechanism and management methods of HFSR caused by sorafenib.Areas covered: The author reviews HFSR caused by the treatment of sorafenib including the mechanism and management. English language reports located through PubMed are reviewed.Expert opinion: There are some conjectures about the mechanism of HFSR. However, the mechanism of HFSR induced by sorafenib is still unclear at present. In the absence of understanding the mechanism of HFSR, the most common method for clinical treatment of sorafenib-induced HFSR is dose down-regulation or discontinuation of treatment, which affects efficacy and even survival. Future research should focus on the mechanism of HFSR to find out new ways for prevention. Precautionary measures before the occurrence of HFSR can also be studied in the future.
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Affiliation(s)
- Leilei Ai
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Ziheng Xu
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Bo Yang
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Qiaojun He
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Peihua Luo
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
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21
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Khaja M, Torchon F, Millerman K. A rare case of sorafenib-induced severe hyponatremia. SAGE Open Med Case Rep 2019; 7:2050313X19846048. [PMID: 31065359 PMCID: PMC6488774 DOI: 10.1177/2050313x19846048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/03/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Sorafenib is an anti-angiogenic tyrosine kinase inhibitor used to treat
patients with renal cell cancer and advanced hepatocellular cancer. Common
adverse effects of sorafenib are rash, diarrhea, nausea, and abnormal liver
function test and hand-foot syndrome. Case presentation: Here, we present a case of a 90-year-old male who was prescribed sorafenib
after being diagnosed with hepatocellular cancer. At 1 week after sorafenib
initiation, he was admitted to the emergency room for an evaluation of
weakness. The patient had hyponatremia, a common electrolyte abnormality
seen in cancer patients. His hyponatremia improved when the sorafenib was
stopped, suggesting that this was a rare case of hyponatremia induced by
sorafenib. Conclusion: Although sorafenib is used in the treatment of hepatocellular cancer, it can
cause life-threatening complication such as hyponatremia. Early
identification of the cause of hyponatremia can prevent serious adverse
event.
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Affiliation(s)
- Misbahuddin Khaja
- Division of Pulmonary/Critical Care Medicine, Bronx Care Health System, Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Frantz Torchon
- Division of Critical Care Medicine, New York-Presbyterian Lawrence Hospital Center, Columbia University Vagelos College of Physicians and Surgeons, Bronxville, NY, USA
| | - Konstantin Millerman
- Division of Critical Care Medicine, New York-Presbyterian Lawrence Hospital Center, Columbia University Vagelos College of Physicians and Surgeons, Bronxville, NY, USA
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22
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Ding F, Liu B, Wang Y. Risk of hand-foot skin reaction associated with vascular endothelial growth factor-tyrosine kinase inhibitors: A meta-analysis of 57 randomized controlled trials involving 24,956 patients. J Am Acad Dermatol 2019; 83:788-796. [PMID: 30991119 DOI: 10.1016/j.jaad.2019.04.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 04/07/2019] [Accepted: 04/10/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Multiple randomized controlled trials have assessed hand-foot skin reaction (HFSR) caused by vascular endothelial growth factor receptor-tyrosine kinase inhibitors (VEGFR-TKIs). OBJECTIVE We performed a meta-analysis to determine the incidence and the relative risk (RR) of HFSR associated with these agents. METHODS Databases were searched for relevant studies. Statistical analyses were conducted to calculate the summary incidences, RR, and 95% confidence intervals (CIs) by using random-effects or fixed-effects models according to the heterogeneity of the included studies. RESULTS A total of 24,956 patients from 57 studies were included. The overall incidence of all-grade and high-grade HFSR associated with VEGFR-TKIs was 35.0% (95% CI, 28.6%-41.6%) and 9.7% (95% CI, 7.3%-12.3%), respectively. The use of VEGFR-TKIs significantly increased the risk of developing all-grade (RR, 5.09; 95% CI, 3.52-7.35; P < .001) and high-grade (RR, 9.42; 95% CI, 5.59-15.90; P < .001) HFSR. Subgroup analyses revealed that the risk of HFSR was significantly increased according to tumor type, VEGFR-TKI, trial phase, treatment regimen, and control therapy. No evidence of publication bias was observed. LIMITATION High heterogeneity in most studies. CONCLUSION High risk of HFSR is prone to develop in cancer patients receiving VEGFR-TKIs.
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Affiliation(s)
- Fengxia Ding
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.
| | - Bo Liu
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yaping Wang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
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Seebacher NA, Stacy AE, Porter GM, Merlot AM. Clinical development of targeted and immune based anti-cancer therapies. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2019; 38:156. [PMID: 30975211 PMCID: PMC6460662 DOI: 10.1186/s13046-019-1094-2] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 02/07/2019] [Indexed: 02/08/2023]
Abstract
Cancer is currently the second leading cause of death globally and is expected to be responsible for approximately 9.6 million deaths in 2018. With an unprecedented understanding of the molecular pathways that drive the development and progression of human cancers, novel targeted therapies have become an exciting new development for anti-cancer medicine. These targeted therapies, also known as biologic therapies, have become a major modality of medical treatment, by acting to block the growth of cancer cells by specifically targeting molecules required for cell growth and tumorigenesis. Due to their specificity, these new therapies are expected to have better efficacy and limited adverse side effects when compared with other treatment options, including hormonal and cytotoxic therapies. In this review, we explore the clinical development, successes and challenges facing targeted anti-cancer therapies, including both small molecule inhibitors and antibody targeted therapies. Herein, we introduce targeted therapies to epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), human epidermal growth factor receptor 2 (HER2), anaplastic lymphoma kinase (ALK), BRAF, and the inhibitors of the T-cell mediated immune response, cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein-1 (PD-1)/ PD-1 ligand (PD-1 L).
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Affiliation(s)
- N A Seebacher
- Faculty of Medicine, The University of Sydney, Camperdown, New South Wales, 2006, Australia
| | - A E Stacy
- Faculty of Medicine, The University of Notre Dame, Darlinghurst, New South Wales, 2010, Australia
| | - G M Porter
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Kensington, New South Wales, 2031, Australia
| | - A M Merlot
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Kensington, New South Wales, 2031, Australia. .,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, 2031, Australia. .,UNSW Centre for Childhood Cancer Research, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, 2031, Australia.
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Cutaneous toxicities of antineoplastic agents: data from a large cohort of Greek patients. Support Care Cancer 2019; 27:4535-4542. [PMID: 30919155 DOI: 10.1007/s00520-019-04751-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/15/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Cutaneous toxicities from novel anticancer treatments are an emerging problem in dermato-oncology. However, the prevalence of those toxicities and necessity of skin consultations are currently unknown. The purpose of our study was to perform an epidemiologic analysis of cutaneous toxicities that were referred to our cutaneous toxicity clinic in Athens, Greece. METHODS All patients examined at the oncodermatology department over a 42-month period were included. Gender, age, type of cancer, type of antineoplastic treatment, and type of toxicity were recorded and analyzed. RESULTS Four hundred fifty-nine patients (182 males, 277 females) with mean age (SD) 60.6 years (13.05) were included in the analysis. Six hundred seventy-two cutaneous toxicities were recorded. Chemotherapy-induced toxicities were the most commonly recorded incidents, with taxanes being the most commonly involved agent. Immune-related adverse events (IRAEs) have steadily increased over the past 3 years. Treatment modifications due to skin toxicities were more common in patients treated with targeted agents and immune checkpoint inhibitors than in those treated with chemotherapy. The toxicities that led to the most treatment modifications were acneiform eruptions and perionychias. The most common IRAEs recorded were psoriasis in 11 patients, followed by pruritus, macular rash, and lichenoid-type eruptions. In addition, 4 interesting cases of IRAEs are discussed. CONCLUSION Antineoplastic treatments can lead to a wide range of cutaneous toxicities. Our study underlines the need for a multidisciplinary approach in oncologic patients. The dermatologists' role is crucial in effectively managing those reactions and preventing antineoplastic drug dose adjustments or discontinuation of treatment.
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25
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Kobayashi K, Kawakami K, Yokokawa T, Aoyama T, Suzuki K, Wakatsuki T, Suenaga M, Sato H, Sugiyama E, Yamaguchi K, Hama T. Association of Hand-Foot Skin Reaction with Regorafenib Efficacy in the Treatment of Metastatic Colorectal Cancer. Oncology 2019; 96:200-206. [PMID: 30763946 DOI: 10.1159/000495989] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Hand-foot skin reaction (HFSR) can deteriorate quality of life in patients receiving regorafenib. Cutaneous toxicity is a main adverse effect of multikinase inhibitors and has also been associated with clinical outcome. This study assessed the association between the antitumor efficacy of regorafenib and HFSR in patients with metastatic colorectal cancer (mCRC). METHODS Patients who received regorafenib at 160 mg/day during the first 3 weeks of each 4-week cycle were divided into subgroups based on whether they developed HFSR between May 2013 and October 2015. Estimates of overall survival and progression-free survival were calculated using the Kaplan-Meier method. RESULTS Ninety-seven patients received at least one dose of regorafenib in this retrospective study. Of these patients, 81.4% (n = 79) experienced HFSR of any grade, and 34.0% (n = 33) had grade 3 HFSR. Among those patients with HFSR at any time during the study, 68.0% (n = 66) underwent the first HFSR event (any grade) during cycle 1. Both overall survival and progression-free survival were improved in patients who had HFSR grade ≥2 at any time compared with those who had HFSR grade ≤1. Multivariate logistic regression analysis revealed a history of HFSR grade ≥2 induced by capecitabine as a significant risk factor for severe HFSR (grade ≥2). CONCLUSIONS Patients with mCRC treated using regorafenib who experienced severe HFSR showed better overall survival than patients without severe HFSR. Severe HFSR may offer an early surrogate marker for the efficacy of regorafenib in patients with mCRC.
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Affiliation(s)
- Kazuo Kobayashi
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kazuyoshi Kawakami
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Yokokawa
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Aoyama
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kenichi Suzuki
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeru Wakatsuki
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mitsukuni Suenaga
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hitoshi Sato
- Division of Pharmacokinetics and Pharmacodynamics, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Erika Sugiyama
- Division of Pharmacokinetics and Pharmacodynamics, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Kensei Yamaguchi
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshihiro Hama
- Department of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Kucharz J, Budnik M, Dumnicka P, Pastuszczak M, Kuśnierz-Cabala B, Demkow T, Popko K, Wiechno P. Hand-Foot Syndrome and Progression-Free Survival in Patients Treated with Sunitinib for Metastatic Clear Cell Renal Cell Carcinoma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1133:35-40. [DOI: 10.1007/5584_2018_328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ochi M, Kamoshida T, Ohkawara A, Ohkawara H, Kakinoki N, Hirai S, Yanaka A. Multikinase inhibitor-associated hand-foot skin reaction as a predictor of outcomes in patients with hepatocellular carcinoma treated with sorafenib. World J Gastroenterol 2018; 24:3155-3162. [PMID: 30065561 PMCID: PMC6064964 DOI: 10.3748/wjg.v24.i28.3155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/09/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the relationship between the onsets of multikinase inhibitor (MKI)-associated hand-foot skin reaction (HFSR) and prognosis under intervention by pharmacists after the introduction of sorafenib.
METHODS We conducted a retrospective study involving 40 patients treated with sorafenib. Intervention by pharmacists began at the time of treatment introduction and continued until the appearance of symptomatic exacerbation or non-permissible adverse reactions. We examined the relationship between MKI-associated HFSR and overall survival (OS) after the initiation of treatment.
RESULTS The median OS was 10.9 mo in the MKI-associated HFSR group and 3.4 mo in the no HFSR group, showing a significant difference in multivariate analysis. A multivariate analysis of the time to treatment failure indicated that the intervention by pharmacists and MKI-associated HFSR were significant factors. The median cumulative dose and the mean medication possession ratio were significantly higher in the intervention group than in the non-intervention group. A borderline significant difference was observed in terms of OS in this group.
CONCLUSION Intervention by pharmacists increased drug adherence. Under increased adherence, MKI-associated HFSR was an advantageous surrogate marker. Intervention by healthcare providers needs to be performed for adequate sorafenib treatment.
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Affiliation(s)
- Masanori Ochi
- Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan
| | - Toshiro Kamoshida
- Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan
| | - Atsushi Ohkawara
- Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan
| | - Haruka Ohkawara
- Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan
| | - Nobushige Kakinoki
- Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan
| | - Shinji Hirai
- Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan
| | - Akinori Yanaka
- Hitachi Medical Education and Research Center, University of Tsukuba, Ibaraki 317-0077, Japan
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Kusari A, Borok J, Han AM, Valderrama AJ, Friedlander SF. Hand-foot-skin reaction related to use of the multikinase inhibitor sorafenib and hard orthotics. Pediatr Dermatol 2018; 35:e206-e209. [PMID: 29766555 DOI: 10.1111/pde.13523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hand-foot-skin reaction is a distinct clinical condition arising in association with the use of multikinase inhibitors, including sorafenib. Because multikinase inhibitors are increasingly being used in children with cancer, recognition of this previously unfamiliar condition is of importance to pediatric dermatologists. We describe the diagnosis and successful treatment of a case of hand-foot-skin reaction in a child taking sorafenib for an unresectable desmoid tumor.
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Affiliation(s)
- Ayan Kusari
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA, USA.,Departments of Dermatology and Pediatrics, School of Medicine, University of California, San Diego, CA, USA
| | - Jenna Borok
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Allison M Han
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA, USA.,Departments of Dermatology and Pediatrics, School of Medicine, University of California, San Diego, CA, USA
| | - Alix Jessika Valderrama
- Department of Dermatology, Centro de Especialistas, Hospital Fundación Cardioinfantil, Bogotá, Colombia
| | - Sheila Fallon Friedlander
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA, USA.,Departments of Dermatology and Pediatrics, School of Medicine, University of California, San Diego, CA, USA
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Zhu Y, Zhang X, Lou X, Chen M, Luo P, He Q. Vascular endothelial growth factor (VEGF) antibody significantly increases the risk of hand-foot skin reaction to multikinase inhibitors (MKIs): A systematic literature review and meta-analysis. Clin Exp Pharmacol Physiol 2018. [PMID: 29543385 PMCID: PMC6032857 DOI: 10.1111/1440-1681.12935] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the use of multikinase inhibitors (MKIs) having emerged in recent years, skin toxicities such as hand-foot skin reaction (HFSR) are primary side effects, and they lack effective prediction methods. Here, we updated a previous systematic review by establishing a meta-analysis of the risk of developing HFSR among patients receiving MKIs and antivascular endothelial growth factor antibody. Publications from PubMed and abstracts presented at the American Society of Clinical Oncology Annual Meeting up to February 5, 2015, were searched to identify relevant studies, and a total of 236 patients with metastatic tumours in nine trials were included for analysis. In the meta-analysis, the pooled incidence rates of all-grade and high-grade HFSR among patients who received the combination therapy were 56.9% [95% confidence interval (CI), 45%-71.1%] and 14.3% (95% CI, 9%-24.2%), respectively, with significant differences observed with MKI monotherapy (P < .05). Further subgroup analysis demonstrated that increasing the dosages of bevacizumab (77.8% vs 51.1%, P = .04) and MKIs (64.3% vs 52.6%, P = .02) significantly increased HFSR incidence. Moreover, combination with chemotherapy exerted a minimal effect on HFSR risk (61% vs 55.3%, P = .5). This updated review and meta-analysis confirm the increased risk of HFSR incidence due to the use of MKIs and antivascular endothelial growth factor antibody. Thus, using these therapies requires safety standards.
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Affiliation(s)
- Yi Zhu
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Xiaochen Zhang
- Department of Medical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoe Lou
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Min Chen
- Department of Pharmacy, Zhejiang Hospital, Hangzhou, China
| | - Peihua Luo
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Qiaojun He
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
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Khan MA, Ali S, Venkatraman SS, Sohail MF, Ovais M, Raza A. Fabrication of poly (butadiene-block-ethylene oxide) based amphiphilic polymersomes: An approach for improved oral pharmacokinetics of Sorafenib. Int J Pharm 2018; 542:196-204. [PMID: 29551745 DOI: 10.1016/j.ijpharm.2018.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/16/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022]
Abstract
Sorafenib (SFN), a hydrophobic anticancer drug, has several limitations predominantly poor aqueous solubility and hepatic first-pass effect, limiting its oral delivery that results into several other complications. Present study aims to develop Sorafenib loaded polymersomes using poly butadiene block poly ethylene oxide (PB-b-PEO), an amphiphilic co-block polymer. Prior to drug loading, critical aggregate concentration (CAC) of polymer was calculated for stable formulation synthesis. The developed SFN loaded PB-b-PEO polymersomes (SFN-PB-b-PEO, test formulation) characterized by DLS and cryo-TEM showed particle size 282 nm, polydispersity (PDI) of less than 0.29 and membrane thickness of about 20 nm. SFN-PB-b-PEO polymersomes demonstrated encapsulation efficiency of 71% and showed sustained drug release up to 144 h. Formulation remained stable for 3 months in suspension form. In vitro cytotoxicity against HepG2 cells showed 1.7 folds improved toxicity compared to SFN suspension. In addition, oral administration of SFN-PB-b-PEO polymersomes in BALB/c mice showed increased Cmax and AUC0-96 by 1.7 and 2.77-fold respectively (p < 0.05) compared to those of SFN suspension (reference formulation). Findings suggest that the SFN-PB-b-PEO polymersomes can be a potential candidate for oral delivery of SFN.
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Affiliation(s)
- Muhammad Adeeb Khan
- NILOP Nanomedicine Research Labs, National Institute of Laser and Optronics, Islamabad, Pakistan; Medical Toxicology Lab, Department of Zoology, University of Azad Jammu and Kashmir, Muzaffarabad, Pakistan; School of Material Science and Engineering (MSE), Nanyang Technological University, Singapore
| | - Shaukat Ali
- Medical Toxicology Lab, Department of Zoology, University of Azad Jammu and Kashmir, Muzaffarabad, Pakistan
| | - Subbu S Venkatraman
- School of Material Science and Engineering (MSE), Nanyang Technological University, Singapore
| | - Muhammad Farhan Sohail
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore Campus, Lahore, Pakistan; Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Ovais
- NILOP Nanomedicine Research Labs, National Institute of Laser and Optronics, Islamabad, Pakistan
| | - Abida Raza
- NILOP Nanomedicine Research Labs, National Institute of Laser and Optronics, Islamabad, Pakistan.
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Kersh AE, Ng S, Chang YM, Sasaki M, Thomas SN, Kissick HT, Lesinski GB, Kudchadkar RR, Waller EK, Pollack BP. Targeted Therapies: Immunologic Effects and Potential Applications Outside of Cancer. J Clin Pharmacol 2018; 58:7-24. [PMID: 29136276 PMCID: PMC5972536 DOI: 10.1002/jcph.1028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 09/13/2017] [Indexed: 12/17/2022]
Abstract
Two pharmacologic approaches that are currently at the forefront of treating advanced cancer are those that center on disrupting critical growth/survival signaling pathways within tumor cells (commonly referred to as "targeted therapies") and those that center on enhancing the capacity of a patient's immune system to mount an antitumor response (immunotherapy). Maximizing responses to both of these approaches requires an understanding of the oncogenic events present in a given patient's tumor and the nature of the tumor-immune microenvironment. Although these 2 modalities were developed and initially used independently, combination regimens are now being tested in clinical trials, underscoring the need to understand how targeted therapies influence immunologic events. Translational studies and preclinical models have demonstrated that targeted therapies can influence immune cell trafficking, the production of and response to chemokines and cytokines, antigen presentation, and other processes relevant to antitumor immunity and immune homeostasis. Moreover, because these and other effects of targeted therapies occur in nonmalignant cells, targeted therapies are being evaluated for use in applications outside of oncology.
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Affiliation(s)
- Anna E. Kersh
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - Spencer Ng
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yun Min Chang
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
- Emory Vaccine Center, Atlanta, GA
| | | | - Susan N. Thomas
- Emory University Winship Cancer Institute, Atlanta, GA, USA
- George W. Woodruff School of Mechanical Engineering, Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Haydn T. Kissick
- Emory University Winship Cancer Institute, Atlanta, GA, USA
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - Gregory B. Lesinski
- Emory University Winship Cancer Institute, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ragini R. Kudchadkar
- Emory University Winship Cancer Institute, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Edmund K. Waller
- Emory University Winship Cancer Institute, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Brian P. Pollack
- Atlanta VA Medical Center, Atlanta, GA, USA
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
- Emory University Winship Cancer Institute, Atlanta, GA, USA
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Li J, Gu J. Hand-foot skin reaction with vascular endothelial growth factor receptor tyrosine kinase inhibitors in cancer patients: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2017; 119:50-58. [DOI: 10.1016/j.critrevonc.2017.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/30/2017] [Accepted: 09/30/2017] [Indexed: 01/19/2023] Open
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Sheng X, Huang T, Qin J, Li Q, Wang W, Deng L, Dong A. Preparation, pharmacokinetics, tissue distribution and antitumor effect of sorafenib-incorporating nanoparticles in vivo. Oncol Lett 2017; 14:6163-6169. [PMID: 29113262 DOI: 10.3892/ol.2017.6934] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 06/02/2017] [Indexed: 01/17/2023] Open
Abstract
Sorafenib is a molecularly targeted drug used for treating hepatocellular carcinoma. However, sorafenib may affect the function of normal hepatocytes, and the clinical application of sorafenib is limited due to its adverse effects. The aim of the current study was to improve the effectiveness of sorafenib by preparing it as a nanoparticle formulation using nanoprecipitation technology. Sorafenib was combined with a polyethylene glycol monomethyl ether-racemic polylactic acid copolymer. The properties of the nanoparticles, including particle size, ξ potential and release efficiency, were measured. The pharmacokinetic profile, tissue distribution and tumor-inhibiting effects of the nanoparticles were determined in vitro and in vivo. Compared with sorafenib, the nanoparticle formulation exhibited a significant increase in in vivo retention time. The concentration of sorafenib in tumor tissues was significantly higher than that in normal tissues following treatment with sorafenib nanoparticles. Sorafenib nanoparticles were more efficacious in inhibiting tumor growth compared with sorafenib alone. The results, provided they can be extended to humans, suggest that sorafenib nanoparticles may specifically target hepatocellular carcinoma.
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Affiliation(s)
- Xia Sheng
- Department of General Surgery, The Third Hospital, The Second Military Medical University, Shanghai 201805, P.R. China.,Department of General Surgery, Putuo Hospital, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Tao Huang
- Department of General Surgery, The Third Hospital, The Second Military Medical University, Shanghai 201805, P.R. China
| | - Jianmin Qin
- Department of General Surgery, The Third Hospital, The Second Military Medical University, Shanghai 201805, P.R. China.,Department of General Surgery, Putuo Hospital, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Qi Li
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Weiwei Wang
- Institute of Chemical Industry, Tianjin University, Tianjin 300072, P.R. China
| | - Liandong Deng
- Institute of Chemical Industry, Tianjin University, Tianjin 300072, P.R. China
| | - Anjie Dong
- Institute of Chemical Industry, Tianjin University, Tianjin 300072, P.R. China
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Validation of a Simple Scoring System to Predict Sorafenib Effectiveness in Patients with Hepatocellular Carcinoma. Target Oncol 2017; 12:795-803. [DOI: 10.1007/s11523-017-0522-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Demirkan S, Gündüz Ö, Devrim T. Sorafenib-asssociated hand-foot syndrome treated with topical calcipotriol. JAAD Case Rep 2017; 3:354-357. [PMID: 28761920 PMCID: PMC5522952 DOI: 10.1016/j.jdcr.2017.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Serkan Demirkan
- Department of Dermatology and Venerology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
| | - Özgür Gündüz
- Department of Dermatology and Venerology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
| | - Tuba Devrim
- Department of Pathology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
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Nikolaou V, Syrigos K, Saif MW. Incidence and implications of chemotherapy related hand-foot syndrome. Expert Opin Drug Saf 2016; 15:1625-1633. [PMID: 27718746 DOI: 10.1080/14740338.2016.1238067] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Hand-foot syndrome (HFS) is a well-established cutaneous adverse event of certain chemotherapeutic agents, mainly capecitabine, continuously infused 5-fluorouracil, docetaxel and pegylated liposomal doxorubicin. Erythema, dysesthesia, pain, cracking and desquamation located on palms and soles are the most characteristic manifestations. Although HFS is a reversible and non-life-threatening clinical condition, it can often affect patient's quality of life significantly, hence necessitating therapeutic modifications or even treatment discontinuation. Areas covered: This is review article on current data regarding the clinical characteristics, grading and management of HFS. Special focus has been given to recent literature studying novel therapeutic strategies. Expert opinion: Early recognition, patient education and supportive measures are considered as the key elements in the management of HFS. Up to date, treatment interruption and dose intensity reduction are the mainstay of HFS management. Many topical formulations and systemic treatment regimens have been proposed, with COX-2 inhibitors being the most promising agents. Nevertheless, large prospective randomized controlled trials are needed in order to agree on solid, evidence-based treatment algorithms.
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Affiliation(s)
- V Nikolaou
- a Oncology Unit, Third Department of Medicine , Athens Medical School, Sotiria General Hospital , Athens , Greece
| | - K Syrigos
- a Oncology Unit, Third Department of Medicine , Athens Medical School, Sotiria General Hospital , Athens , Greece
| | - M W Saif
- b GI Oncology Experimental Therapeutic , Tufts Medical Center, Tufts Cancer Center , Boston , MA , USA
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Synthesis of thermosensitive magnetic nanocarrier for controlled sorafenib delivery. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 67:42-50. [DOI: 10.1016/j.msec.2016.05.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 04/06/2016] [Accepted: 05/09/2016] [Indexed: 12/12/2022]
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Chanprapaph K, Rutnin S, Vachiramon V. Multikinase Inhibitor-Induced Hand-Foot Skin Reaction: A Review of Clinical Presentation, Pathogenesis, and Management. Am J Clin Dermatol 2016; 17:387-402. [PMID: 27221667 DOI: 10.1007/s40257-016-0197-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Multikinase inhibitors (MKIs) are targeted cancer therapies designed to inhibit multiple tyrosine kinase pathways responsible for tumor proliferation, growth, and survival. These agents are more able to target cancer cells and possess better safety profiles than conventional chemotherapies. However, MKIs can produce significant cutaneous adverse events, hand-foot skin reaction (HFSR) being the most clinically significant. Although not life threatening, HFSR can lead to MKI dose modification, interruption, or termination, potentially limiting the anti-tumor effect. This article summarizes the current knowledge concerning the epidemiology, clinical presentation, pathogenesis, histopathology, prognostic implication, and current evidence-based prophylactic and reactive treatment options for MKI-induced HFSR. Its high incidence and significant impact on the quality of life emphasizes the great need to understand the pathogenesis and improve management of this condition.
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Affiliation(s)
- Kumutnart Chanprapaph
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
| | - Suthinee Rutnin
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
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Zhang Y, Xuan L, Fan Z, Huang F, Jiang Q, Xu N, Gao Y, Sun J, Liu Q. [Sorafenib as salvage therapy in refractory relapsed acute myeloid leukemia with positive FLT3 mutation]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:292-6. [PMID: 27093991 PMCID: PMC7343102 DOI: 10.3760/cma.j.issn.0253-2727.2016.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To analyze the effect of sorafenib as salvage therapy used before and/or after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in refractory relapsed FLT3-positive acute myeloid leukemia (AML). METHODS A total of 16 patients with refractory relapsed FLT3-positive AML, including 10 refractory relapsed pre-transplantation and 6 relapsed after allo-HSCT, were enrolled in this retrospective study. Sorafenib treatment protocols included sorafenib in combination with chemotherapy inducing remission, and sorafenib monotherapy as mauntenance treatment after complete remission (CR). RESULTS Thirteen of the 16 patients achieved CR after one or two courses of induction therapy, including 7 refractory relapsed pre-transplantation and 6 relapsed after allo-HSCT. With a median follow up of 472 (range, 59-1569) days post-transplantation, 12 patients survived and 4 died. Causes of death included leukemia relapse (n=3) and acute graft-versus-host disease (n=1). The 2-year overall and disease-free survival post-transplantation of the 16 patients were (75.0±10.8) % and (50.5±13.7) % respectively. The main side effect of sorafenib was the skin rash. The incidence of rash was lower in the patients used sorafenib pre-transplantation than those post-transplantation (30.0% vs 75.0%, P=0.043). CONCLUSION Sorafenib used as salvage therapy befor and/or after transplantation for refractory relapsed FLT3-positive AML could reduce the relapse rate and improve the survival.
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Affiliation(s)
- Yu Zhang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Aydin MM, Bayin NS, Acun T, Yakicier MC, Akçali KC. Role of FLT3 in the proliferation and aggressiveness of hepatocellular carcinoma. Turk J Med Sci 2016; 46:572-81. [PMID: 27511526 DOI: 10.3906/sag-1501-173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 05/26/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Previously we showed that Fms-like tyrosine kinase (FLT3) changes its cellular localization upon partial hepatectomy, suggesting a role in liver regeneration. FLT3 was also shown to play an important function in cellular proliferation and activation of PI3K and Ras. Thus, we aimed to investigate the role of FLT3 in hepatocellular tumorigenesis utilizing in vitro and in vivo models. MATERIALS AND METHODS We used Snu398 cells that express FLT3. We investigated these cells' in vitro proliferation and invasion abilities by treatment with the FLT3 inhibitor K-252a or by knocking-down with FLT3 shRNA,. Furthermore, the effect of blocking FLT3 activity and expression during in vivo tumorigenesis was assessed with xenograft models. RESULTS After K-252a treatment or stable knock-down, these cells' proliferation and migration abilities were highly diminished in vitro. In addition, significant diminution in tumorigenicity of Snu398 cells was also obtained in vivo. When FLT3 knocked-down Snu398 cells were injected into nude mice, we did not detect αSMA expression in these tumors, suggesting a role for FLT3 in in vivo invasiveness. CONCLUSION Our data provided evidence that FLT3 has a crucial role both in hepatocarcinogenesis and its invasiveness. Therefore, targeting FLT3 and/or its activity may be a promising tool for combating hepatocellular carcinomas.
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Affiliation(s)
- Muammer Merve Aydin
- Department of Molecular Biology and Genetics, Bilkent University, Ankara, Turkey
| | - Nermin Sumru Bayin
- Department of Molecular Biology and Genetics, Bilkent University, Ankara, Turkey
| | - Tolga Acun
- Department of Molecular Biology and Genetics, Faculty of Sciences and Arts, Bülent Ecevit University, Zonguldak, Turkey
| | | | - Kamil Can Akçali
- Department of Biophysics, Ankara University, Faculty of Medicine, Ankara, Turkey
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Worden F, Fassnacht M, Shi Y, Hadjieva T, Bonichon F, Gao M, Fugazzola L, Ando Y, Hasegawa Y, Park DJ, Shong YK, Smit JWA, Chung J, Kappeler C, Meinhardt G, Schlumberger M, Brose MS. Safety and tolerability of sorafenib in patients with radioiodine-refractory thyroid cancer. Endocr Relat Cancer 2015; 22:877-87. [PMID: 26370187 PMCID: PMC4570090 DOI: 10.1530/erc-15-0252] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Effective adverse event (AE) management is critical to maintaining patients on anticancer therapies. The DECISION trial was a multicenter, randomized, double-blind, placebo-controlled, Phase 3 trial which investigated sorafenib for treatment of progressive, advanced, or metastatic radioactive iodine-refractory, differentiated thyroid carcinoma. Four hundred and seventeen adult patients were randomized (1:1) to receive oral sorafenib (400 mg, twice daily) or placebo, until progression, unacceptable toxicity, noncompliance, or withdrawal. Progression-free survival, the primary endpoint of DECISION, was reported previously. To elucidate the patterns and management of AEs in sorafenib-treated patients in the DECISION trial, this report describes detailed, by-treatment-cycle analyses of the incidence, prevalence, and severity of hand-foot skin reaction (HFSR), rash/desquamation, hypertension, diarrhea, fatigue, weight loss, increased serum thyroid stimulating hormone, and hypocalcemia, as well as the interventions used to manage these AEs. By-cycle incidence of the above-selected AEs with sorafenib was generally highest in cycle 1 or 2 then decreased. AE prevalence generally increased over cycles 2-6 then stabilized or declined. Among these AEs, only weight loss tended to increase in severity (from grade 1 to 2) over time; severity of HFSR and rash/desquamation declined over time. AEs were mostly grade 1 or 2, and were generally managed with dose interruptions/reductions, and concomitant medications (e.g. antidiarrheals, antihypertensives, dermatologic preparations). Most dose interruptions/reductions occurred in early cycles. In conclusion, AEs with sorafenib in DECISION were typically grade 1 or 2, occurred early during the treatment course, and were manageable over time.
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MESH Headings
- Adenocarcinoma, Follicular/drug therapy
- Adenocarcinoma, Follicular/enzymology
- Adenocarcinoma, Follicular/radiotherapy
- Adenoma, Oxyphilic/drug therapy
- Adenoma, Oxyphilic/enzymology
- Adenoma, Oxyphilic/radiotherapy
- Aged
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Carcinoma, Papillary/drug therapy
- Carcinoma, Papillary/enzymology
- Carcinoma, Papillary/radiotherapy
- Diarrhea/chemically induced
- Diarrhea/drug therapy
- Diarrhea/epidemiology
- Disease-Free Survival
- Drug Eruptions/drug therapy
- Drug Eruptions/epidemiology
- Drug Eruptions/etiology
- Drug Resistance, Neoplasm
- Dyspnea/chemically induced
- Dyspnea/epidemiology
- Fatigue/chemically induced
- Fatigue/epidemiology
- Female
- Humans
- Hypertension/chemically induced
- Hypertension/drug therapy
- Hypertension/epidemiology
- Hypocalcemia/chemically induced
- Hypocalcemia/epidemiology
- Incidence
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/epidemiology
- Niacinamide/adverse effects
- Niacinamide/analogs & derivatives
- Niacinamide/therapeutic use
- Phenylurea Compounds/adverse effects
- Phenylurea Compounds/therapeutic use
- Prevalence
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Radiopharmaceuticals/therapeutic use
- Sorafenib
- Thyroid Neoplasms/drug therapy
- Thyroid Neoplasms/enzymology
- Thyroid Neoplasms/radiotherapy
- Weight Loss/drug effects
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Affiliation(s)
- Francis Worden
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin Fassnacht
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadioth
| | - Yuankai Shi
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadioth
| | - Tatiana Hadjieva
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Françoise Bonichon
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ming Gao
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura Fugazzola
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadioth
| | - Yuichi Ando
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yasuhisa Hasegawa
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Do Joon Park
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Young Kee Shong
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Johannes W A Smit
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Chung
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian Kappeler
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gerold Meinhardt
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin Schlumberger
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marcia S Brose
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Reck M, Mellemgaard A, von Pawel J, Gottfried M, Bondarenko I, Cheng Y, Zarogoulidis K, Luft A, Bennouna J, Barrueco J, Aboshady H, Hocke J, Kaiser R, Douillard JY. Anti-angiogenic-specific adverse events in patients with non-small cell lung cancer treated with nintedanib and docetaxel. Lung Cancer 2015; 90:267-73. [PMID: 26415992 DOI: 10.1016/j.lungcan.2015.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/04/2015] [Accepted: 08/08/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES LUME-Lung 1 was a randomized, placebo-controlled, Phase III trial investigating nintedanib+docetaxel versus placebo+docetaxel in patients with advanced NSCLC progressing after first-line chemotherapy. Progression-free survival was significantly improved with nintedanib+docetaxel in the overall population and overall survival was significantly improved in the pre-specified analysis of patients with adenocarcinoma. We evaluated the frequency of characteristic adverse events (AEs) commonly seen with existing anti-angiogenic agents. MATERIALS AND METHODS The incidence and intensity of AEs were evaluated in all patients who received at least one dose of study medication (N=1307) and for the two main histologies: adenocarcinoma (n=653) and squamous cell carcinoma (SCC; n=553). AEs of special interest were analyzed by category, preferred term, and worst CTCAE grade and included perforation, hypertension, bleeding, thromboembolic events, and skin disorders. RESULTS AND CONCLUSION The incidence of patients with all-grade gastrointestinal (GI) perforations was low and balanced between arms (0.5% in both) and across histologies; the incidence of non-GI perforations was 1.2% with nintedanib+docetaxel versus 0.2% with placebo+docetaxel. The incidence of some events was higher with nintedanib+docetaxel versus placebo+docetaxel; hypertension (3.5% vs 0.9%), rash (11.0% vs 8.1%), and cutaneous adverse reactions (13.0% vs 10.7%). Rash and cutaneous adverse reactions were predominantly Grade 1-2 with both treatments. The incidence of all-grade bleeding was also slightly higher in nintedanib+docetaxel-treated patients (14.1% vs 11.6%) driven by between-treatment differences in the SCC subpopulation; most events were Grade 1-2. The proportion of patients with a thromboembolic event was low and comparable between arms for all grades (5.1% vs 4.6%) and Grade ≥3 (2.1% vs 3.1%). Safety evaluation of the LUME-Lung 1 study showed that the frequency of AEs commonly associated with other anti-angiogenic agents was lower with nintedanib+docetaxel. Survival benefits from addition of nintedanib to docetaxel in patients with adenocarcinoma after first-line therapy can be achieved alongside a manageable safety profile.
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Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany.
| | | | | | - Maya Gottfried
- Lung Cancer Unit, Meir Medical Center, Kfar Saba, Israel
| | - Igor Bondarenko
- Clinical Facility, Dnepropetrovsk Medical Academy, Clinical Hospital #4, Dnepropetrovsk, Ukraine
| | - Ying Cheng
- Division of Thoracic Oncology, Jilin Province Cancer Hospital, Changchun, China
| | - Kostas Zarogoulidis
- Pulmonary Department-Oncology Unit, General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Alexander Luft
- Department of Thoracic Surgery, Leningrad Regional Clinical Hospital, St. Petersburg, Russia
| | - Jaafar Bennouna
- Department of Medical Oncology, Centre René Gauducheau, Nantes, France
| | - José Barrueco
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Hesham Aboshady
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Julia Hocke
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Rolf Kaiser
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
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McLellan B, Ciardiello F, Lacouture ME, Segaert S, Van Cutsem E. Regorafenib-associated hand-foot skin reaction: practical advice on diagnosis, prevention, and management. Ann Oncol 2015; 26:2017-26. [PMID: 26034039 PMCID: PMC4576906 DOI: 10.1093/annonc/mdv244] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/12/2015] [Indexed: 12/13/2022] Open
Abstract
Regorafenib is an oral multikinase inhibitor licensed for use in gastrointestinal cancers. In clinical trials, regorafenib showed a consistent toxicity profile, including clinically significant hand–foot skin reaction (HFSR). Treatment modifications and symptomatic measures, as recommended in this review, can be used to manage HFSR and help patients to continue treatment at an optimal dose. Background Regorafenib is an orally available, small-molecule multikinase inhibitor with international marketing authorizations for use in colorectal cancer and gastrointestinal stromal tumors. In clinical trials, regorafenib showed a consistent and predictable adverse-event profile, with hand–foot skin reaction (HFSR) among the most clinically significant toxicities. This review summarizes the clinical characteristics of regorafenib-related HFSR and provides practical advice on HFSR management to enable health care professionals to recognize, pre-empt, and effectively manage the symptoms, thereby allowing patients to remain on active therapy for as long as possible. Design This review is based on a systematic literature search of the PubMed database (using synonyms of HFSR, regorafenib, and skin toxicities associated with targeted therapies or cytotoxic chemotherapy). However, as this search identified very few articles, the authors also use their clinical experience as oncologists and dermatologists managing patients with treatment-related HFSR to provide recommendations on recognition and management of HFSR in regorafenib-treated patients. Results Regorafenib-related HFSR is similar to that seen with other multikinase inhibitors (e.g. sorafenib, sunitinib, cabozantinib, axitinib, and pazopanib) but differs from the hand–foot syndrome seen with cytotoxic chemotherapies (e.g. fluoropyrimidines, anthracyclines, and taxanes). There have been no controlled trials of symptomatic management of regorafenib-related HFSR, and limited good-quality evidence from randomized clinical trials of effective interventions for HFSR associated with other targeted therapies. Recommendations on prevention and management of regorafenib-related HFSR in this review are therefore based on the expert opinion of the authors (dermatologists and oncologists with expertise in the management of treatment-related skin toxicities and oncologists involved in clinical trials of regorafenib) and tried-and-tested empirical experience with other multikinase inhibitors and cytotoxic chemotherapies. Conclusions As recommended in this review, treatment modifications and supportive measures to prevent, reduce, and manage HFSR can allow patients to continue regorafenib at the optimal dose to derive benefit from treatment.
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Affiliation(s)
- B McLellan
- Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, USA
| | - F Ciardiello
- Seconda Università degli Studi di Napoli, Napoli, Italy
| | - M E Lacouture
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - S Segaert
- University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - E Van Cutsem
- University Hospitals Leuven and KU Leuven, Leuven, Belgium
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Belum VR, Serna-Tamayo C, Wu S, Lacouture ME. Incidence and risk of hand-foot skin reaction with cabozantinib, a novel multikinase inhibitor: a meta-analysis. Clin Exp Dermatol 2015; 41:8-15. [PMID: 26009777 DOI: 10.1111/ced.12694] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cabozantinib is approved in the treatment of progressive, metastatic medullary thyroid cancer (MTC). It is a small molecule inhibitor, which targets multiple receptors, including vascular endothelial growth factor receptor, tyrosine kinase with Ig and epidermal growth factor homology domains-2 and the proto-oncogenes MET (mesenchymal-epithelial transition factor) and RET (rearranged during transfection). The drug is currently in phase I/II/III clinical trials for a number of other solid tumours and haematological malignancies. The adverse event (AE) profile is similar to that of other newer angiogenesis inhibitors. Hand-foot skin reaction (HFSR) is an important dose-limiting dermatological adverse event of this class of drugs. AIM To ascertain the incidence and risk of HFSR in patients with cancer during treatment with cabozantinib. METHODS Electronic databases (PubMed, Web of Science) and the American Society of Clinical Oncology Meeting Library were queried from inception to July 2014. Only phase II/III studies investigating cabozantinib for the treatment of cancer were shortlisted. The incidence, relative risk (RR) and 95% CI were calculated using random- or fixed-effects models, depending on the heterogeneity of the included studies. RESULTS We included 831 patients treated with cabozantinib for various solid malignancies in the analysis. The overall incidence was 35.3% (95% CI 27.9-43.6%) for all-grade and 9.5% (95% CI 7.6-11.7%) for high-grade HFSR. The RR of all-grade and high-grade HFSR with cabozantinib, compared with controls, was increased for both all-grade (27.3; 95% CI 6.9-108.3; P < 0.001) and high-grade (28.1; 95% CI 1.7-457; P < 0.02) HFSR, respectively. CONCLUSIONS The incidence and risk of developing HFSR with cabozantinib are high. Timely recognition of this dose-limiting AE is critical to direct supportive care efforts including patient counselling, and to institute preventative and/or treatment interventions.
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Affiliation(s)
- V R Belum
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C Serna-Tamayo
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Wu
- Division of Medical Oncology, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.,Division of Haematology and Oncology, Department of Medicine, Northport VA Medical Center, Northport, NY, USA
| | - M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Grassi P, Verzoni E, Porcu L, Iacovelli R, de Braud F, Procopio G. Sites of disease as predictors of outcome in metastatic renal cell carcinoma patients treated with first-line sunitinib or sorafenib. Ther Adv Urol 2015; 7:59-68. [PMID: 25829949 DOI: 10.1177/1756287215571809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This study investigated whether the effectiveness of first-line tyrosine-kinase inhibitors was associated with sites of disease in patients with metastatic renal cell carcinoma (mRCC). METHODS A retrospective cohort of consecutive mRCC patients receiving first-line sorafenib (SO) or sunitinib (SU) was analyzed. RESULTS In total, 203 patients received SO and 99 SU. In patients with liver metastasis, SU was associated with a 18% higher risk of time-to-treatment failure (TTF), and a 39% higher risk of death than SO: conversely, patients without liver metastases who received SU showed a 46% decreased risk of TTF and 62% decreased risk of death. CONCLUSIONS mRCC patients with liver metastases treated with first-line SO showed a better outcome compared with SU, while mRCC patients without liver metastases treated with first-line SU showed a better outcome compared with SO.
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Affiliation(s)
- Paolo Grassi
- Medical Oncology 1, Fondazione IRCCS, Istituto Nazionale Tumori, Via G. Venezian 1, Milan, Italy
| | - Elena Verzoni
- Medical Oncology 1, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
| | - Luca Porcu
- Laboratory of Methodology for Biomedical Research, Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Roberto Iacovelli
- Medical Oncology 1, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
| | - Filippo de Braud
- Medical Oncology 1, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
| | - Giuseppe Procopio
- Medical Oncology 1, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
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Ren Z, Zhu K, Kang H, Lu M, Qu Z, Lu L, Song T, Zhou W, Wang H, Yang W, Wang X, Yang Y, Shi L, Bai Y, Guo X, Ye SL. Randomized Controlled Trial of the Prophylactic Effect of Urea-Based Cream on Sorafenib-Associated Hand-Foot Skin Reactions in Patients With Advanced Hepatocellular Carcinoma. J Clin Oncol 2015; 33:894-900. [DOI: 10.1200/jco.2013.52.9651] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose To assess whether urea-based cream (UBC) has prophylactic benefits on sorafenib-induced hand-foot skin reaction (HFSR) in patients with advanced hepatocellular carcinoma (HCC). Patients and Methods In this randomized, open-label trial, 871 patients with advanced HCC throughout China were treated with 10% UBC three times per day plus best supportive care (BSC; n = 439) or BSC alone excluding all creams (n = 432), starting on day 1 of sorafenib treatment, for up to 12 weeks. HFSR was assessed every 2 weeks and at 14 weeks for patients completing the study. Once HFSR occurred, patients were allowed any cream, including a UBC. Results The 12-week incidence of any grade HFSR was significantly lower in the UBC group versus the BSC-alone group (56.0% v 73.6%, respectively; odds ratio [OR], 0.457; 95% CI, 0.344 to 0.608; P < .001), as was the incidence of grade ≥ 2 HFSR (20.7% v 29.2%, respectively; OR, 0.635; 95% CI, 0.466 to 0.866; P = .004). Median time to first occurrence of HFSR was significantly longer in the UBC group than the BSC-alone group (84 v 34 days, respectively; hazard ratio, 0.658; 95% CI, 0.541 to 0.799; P < .001). Elevated AST was associated with increased risk of HFSR but did not alter the treatment effect of UBC. UBC plus BSC, compared with BSC alone, did not affect the sorafenib dose reduction or interruption rate (9.1% v 11.8%, respectively; P = .1937), response rate (11.1% v 10.1%, respectively; P = .6674), or disease control rate (98.8% v 98.2%, respectively; P = .5350) at week 12. Conclusion UBC prophylaxis in patients with advanced HCC starting sorafenib reduced HFSR rates, extended the time to first occurrence of HFSR, and improved patient quality of life compared with BSC. Blinded, randomized, placebo-controlled trials to determine the role of UBC on the incidence and severity of HFSR are warranted.
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Affiliation(s)
- ZhengGang Ren
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - KangShun Zhu
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - HaiYan Kang
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - MinQiang Lu
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - ZengQiang Qu
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - LiGong Lu
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - TianQiang Song
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - WeiPing Zhou
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - Hui Wang
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - WeiZhu Yang
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - Xuan Wang
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - YongPing Yang
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - LeHua Shi
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - YuXian Bai
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - XiaoFeng Guo
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
| | - Sheng-Long Ye
- ZhengGang Ren and Sheng-Long Ye, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education; ZengQiang Qu, WeiPing Zhou, and LeHua Shi, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University, Shanghai; KangShun Zhu and MinQiang Lu, The Third Affiliated Hospital of Sun Yat-sen University; LiGong Lu, Guangdong Provincial People's Hospital, Guangdong; HaiYan Kang, 301 Military Hospital; YongPing Yang
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Blair HA, Plosker GL. Sorafenib: a review of its use in patients with radioactive iodine-refractory, metastatic differentiated thyroid carcinoma. Target Oncol 2015; 10:171-8. [PMID: 25742918 DOI: 10.1007/s11523-015-0363-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/13/2015] [Indexed: 12/15/2022]
Abstract
Sorafenib (Nexavar®) is the first tyrosine kinase inhibitor to be approved for the treatment of radioactive iodine (RAI)-refractory differentiated thyroid carcinoma (DTC). In the pivotal phase III DECISION trial in patients with RAI-refractory, locally advanced or metastatic DTC, oral sorafenib 400 mg twice daily significantly prolonged median progression-free survival (PFS) relative to placebo. The PFS benefit of sorafenib over placebo was evident in all pre-specified clinical and genetic biomarker subgroups, and neither BRAF nor RAS mutation status was predictive of sorafenib benefit for PFS. The objective response rate was significantly higher in patients receiving sorafenib than in those receiving placebo; all objective responses were partial responses. The overall survival benefit of sorafenib is as yet unclear, with no significant benefit observed at the time of primary analysis or at 9 months following the primary analysis. Overall survival was possibly confounded by the crossover of patients in the placebo group to sorafenib upon disease progression. The adverse events associated with sorafenib in the DECISION trial were consistent with the known tolerability profile of the drug, with hand-foot skin reaction, diarrhea, and alopecia reported most commonly. Most treatment-emergent adverse events were grade 1 or 2 in severity and occurred early in treatment. However, a high proportion of patients discontinued sorafenib therapy or required dose reductions or interruptions because of toxicity. Although final overall survival data are awaited, current evidence suggests that sorafenib is a promising new treatment option for patients with RAI-refractory, metastatic DTC.
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Affiliation(s)
- Hannah A Blair
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand,
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