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Montero P, Pérez-Leal M, Pérez-Fidalgo JA, Sanz C, Estornut C, Roger I, Milara J, Cervantes A, Cortijo J. Paclitaxel Induces Epidermal Molecular Changes and Produces Subclinical Alterations in the Skin of Gynecological Cancer Patients. Cancers (Basel) 2022; 14:cancers14051146. [PMID: 35267454 PMCID: PMC8909563 DOI: 10.3390/cancers14051146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Skin toxicity is one of paclitaxel’s adverse effects. However, its real impact on the skin could be underestimated as these alterations can also appear asymptomatic. We have observed that paclitaxel modifies gene and protein expression of skin markers in a 3D epidermis model, and impairs physical, physiological, and biomechanical properties of the skin in gynecologic cancer patients. These subclinical alterations might be avoided by using prophylactic measures during treatment to prevent possible future adverse reactions. Abstract Background: Paclitaxel is a microtubule-stabilizing chemotherapeutic agent. Despite its widespread use, it damages healthy tissues such as skin. The goal of this study was to prove that the real impact of paclitaxel-induced skin toxicity could be underestimated because the adverse events might appear asymptomatic. Methods: Gynecological cancer patients were recruited. Skin parameters measurements were taken after three and six paclitaxel cycles. Measurements were conducted using specific probes which measure hydration, transepidermal water loss (TEWL), sebum, elasticity and firmness, erythema, roughness, smoothness, skin thickness, and desquamation levels. Further, a 3D epidermis model was incubated with paclitaxel to analyze gene and protein expression of aquaporin 3, collagen type 1, elastin, and fibronectin. Results: Paclitaxel induced alterations in the skin parameters with no visible clinical manifestations. Gynecological cancer patients under paclitaxel treatment had a decrease in hydration, TEWL, sebum, elasticity, and thickness of the skin, while erythema, roughness, and desquamation were increased. The molecular markers, related to hydration and the support of the skin layers, and analyzed in the 3D epidermis model, were decreased. Conclusions: Results suggest that paclitaxel modifies gene and protein expression of skin-related molecular markers, and impairs different physical, physiological, and biomechanical properties of the skin of cancer patients at a subclinical level.
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Affiliation(s)
- Paula Montero
- Department of Pharmacology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (C.S.); (C.E.); (I.R.); (J.M.); (J.C.)
- Correspondence: ; Tel.: +34-963864631
| | - Martín Pérez-Leal
- Faculty of Health Sciences, Universidad Europea de Valencia, 46010 Valencia, Spain;
| | - Jose Alejandro Pérez-Fidalgo
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
- Biomedical Research Networking Centre on Cancer (CIBERONC), Health Institute Carlos III, 28029 Madrid, Spain
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain;
| | - Celia Sanz
- Department of Pharmacology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (C.S.); (C.E.); (I.R.); (J.M.); (J.C.)
- Health Sciences, Pre-Departmental Section of Medicine, Jaume I University of Castellón de la Plana, 12071 Castellón, Spain
| | - Cristina Estornut
- Department of Pharmacology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (C.S.); (C.E.); (I.R.); (J.M.); (J.C.)
| | - Inés Roger
- Department of Pharmacology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (C.S.); (C.E.); (I.R.); (J.M.); (J.C.)
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Health Institute Carlos III, 28029 Madrid, Spain
| | - Javier Milara
- Department of Pharmacology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (C.S.); (C.E.); (I.R.); (J.M.); (J.C.)
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Health Institute Carlos III, 28029 Madrid, Spain
- Pharmacy Unit, University General Hospital Consortium, 46014 Valencia, Spain
| | | | - Julio Cortijo
- Department of Pharmacology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (C.S.); (C.E.); (I.R.); (J.M.); (J.C.)
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Health Institute Carlos III, 28029 Madrid, Spain
- Research and Teaching Unit, University General Hospital Consortium, 46014 Valencia, Spain
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Fontenot AL, Furr WJ, Husan A, Khan MW. Erythrodysesthesia: An Unusual Complication With Trastuzumab Monotherapy. Cureus 2021; 13:e20060. [PMID: 34993032 PMCID: PMC8720033 DOI: 10.7759/cureus.20060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
Palmar-plantar erythrodysesthesia (PPE), more commonly known as hand-foot syndrome, is a dermatologic complication following chemotherapy with selective agents. In this article, we present the case of a young lady with stage III breast cancer who developed palmar-plantar erythrodysesthesia following treatment with Herceptin (trastuzumab), an unusual complication of this particular drug. From our review of literature, this is the second known occurrence of PPE secondary to trastuzumab monotherapy.
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Kewan T, Alomari M, Khazaaleh S, Covut F, Olayan M. Hand-foot Syndrome Secondary to Low-dose Docetaxel in a Breast Cancer Patient. Cureus 2019; 11:e4400. [PMID: 31245190 PMCID: PMC6559678 DOI: 10.7759/cureus.4400] [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: 03/25/2019] [Accepted: 04/04/2019] [Indexed: 11/05/2022] Open
Abstract
Docetaxel-induced hand-foot syndrome (HFS) at low doses is a very rare side effect that usually occurs in a dose-dependent manner. HFS can be managed with conservative measures and may need chemotherapy discontinuation. In this report we present a case of HFS in a breast cancer patient after one dose of docetaxel.
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Affiliation(s)
- Tariq Kewan
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | | | | | - Fahrettin Covut
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - May Olayan
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
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Abstract
Taxanes (docetaxel and paclitaxel) are among the most commonly prescribed anticancer drugs approved for the treatment of metastatic or locally advanced breast, non-small cell lung, prostate, gastric, head and neck, and ovarian cancers, as well as in the adjuvant setting for operable node-positive breast cancers. Although the true incidence of dermatological adverse events (AEs) in patients receiving taxanes is not known, and has never been prospectively analysed, they clearly represent one of the major AEs associated with these agents. With an increase in the occurrence of cutaneous AEs during treatment with novel targeted and immunological therapies when used in combination with taxanes, a thorough understanding of reactions attributable to this class is imperative. Moreover, identification and management of dermatological AEs is critical for maintaining the quality of life in cancer patients and for minimizing dose modifications of their antineoplastic regimen. This analysis represents a systematic review of the dermatological conditions reported with the use of these drugs, complemented by experience at comprehensive cancer centres. The conditions reported herein include skin, hair, and nail toxicities. Lastly, we describe the dermatological data available for the new, recently FDA-and EMA- approved, solvent-free nab-paclitaxel.
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6
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Dar W, Hussain M, Aziz SA, Mohammad G, Wani B, Latief M. Uncommon Adverse Effects of Commonly Used Chemotherapeutic Agents in Medical Oncology Practice: A Series of Two Cases of Hand-Foot Syndrome. Indian J Med Paediatr Oncol 2017; 38:380-382. [PMID: 29200697 PMCID: PMC5686990 DOI: 10.4103/ijmpo.ijmpo_70_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chemotherapy has an increasing potential for cure and palliation of most forms of cancer in different stages. However, its use is associated with a multitude of side effects some very common and few very rare. We present two patients of metastatic nonsmall lung cancer who had severe forms of hand-foot syndrome with two different classes of antineoplastic drugs and have to discontinue chemotherapy.
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Affiliation(s)
- Waseem Dar
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mir Hussain
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sheikh Aijaz Aziz
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Gul Mohammad
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Burhan Wani
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Muzamil Latief
- Department of Medical Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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7
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Pineda R, Rojas P, Martínez P, Zambrano G, Morales C, de Barrio M. Erythrodysestesia-like skin eruption due to docetaxel with a nonimmediate positive intradermal skin test result. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:341-2. [DOI: 10.1016/j.jaip.2015.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/12/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
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8
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Quantitative changes in skin composition parameters due to chemotherapy in breast cancer patients: a cohort study. Breast Cancer Res Treat 2015. [DOI: 10.1007/s10549-015-3502-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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9
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Dow EN, Piccolo J, Segal EM, Charlson JA. Drug induced periarticular thenar erythema with onycholysis related to nano-albumin bound paclitaxel therapy. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ctrc.2015.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Tsuboi H, Yonemoto K, Katsuoka K. A Case of Bleomycin-Induced Acral Erythema (AE) with Eccrine Squamous Syringometaplasia (ESS) and Summary of Reports of AE with ESS in the Literature. J Dermatol 2014; 32:921-5. [PMID: 16361756 DOI: 10.1111/j.1346-8138.2005.tb00873.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Accepted: 06/24/2005] [Indexed: 11/29/2022]
Abstract
Chemotherapy-induced acral erythema (AE) is primarily induced by hydroxyurea, methotrexate, and cytarabine, although there are rare reports of AE induced by combination chemotherapy containing bleomycin. It is thought that the accumulation of chemotherapeutic drugs in eccrine glands may cause eccrine squamous syringometaplasia (ESS), which is characterized by metaplasia and focal necrosis of the epithelium of the eccrine duct. ESS is occasionally detected in conjunction with AE, but such occurrences are relatively uncommon. This is the first report of AE with ESS induced by the administration of bleomycin alone. We also provide a summary of past cases of AE with ESS in the literature.
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Affiliation(s)
- Hiromi Tsuboi
- Department of Dermatology, Kitasato University School of Medicine, Kanagawa, Japan
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11
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Ho MY, Mackey JR. Presentation and management of docetaxel-related adverse effects in patients with breast cancer. Cancer Manag Res 2014; 6:253-9. [PMID: 24904223 PMCID: PMC4041377 DOI: 10.2147/cmar.s40601] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The taxane chemotherapeutic agent docetaxel has been utilized in the management of breast cancer in the adjuvant, neoadjuvant and metastatic setting. Although well tolerated by the majority of patients, docetaxel toxicity may limit the dose which can be administered. Adverse events include infusion reactions, febrile neutropenia, fatigue, fluid retention, pneumonitis, cutaneous and nail toxicity, epiphora and lacrimal duct stenosis, gastrointestinal complications, and neuropathies. In this review, we explore these complications and how they can be effectively managed to improve patient quality of life during and following docetaxel therapy.
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Affiliation(s)
- Maria Y Ho
- Division of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - John R Mackey
- Division of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
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12
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Guerra JR, Suelves AM, Bella A, Lolo D. Hand, foot and scrotal blisters in a patient with cancer receiving oral chemotherapy. BMJ Case Rep 2014; 2014:bcr-2013-202822. [PMID: 24842353 DOI: 10.1136/bcr-2013-202822] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Tyrosine kinase inhibitors are novel antineoplastic drugs that make use of the molecular abnormalities that have been discovered in certain types of tumours. These agents are associated with important dermatological side effects. This case report discusses an atypical presentation of the hand-foot syndrome in one patient treated with sorafenib. A 78-year-old man, recently started on sorafenib for the treatment of hepatocarcinoma with lung metastasis, presented to the emergency room with painful blistering lesions on the palms, soles and scrotum for 1 week. A punch biopsy was performed and sorafenib was withheld. Direct immunofluorescence study was negative for an autoimmune blistering disorder and histopathology stains did not show any microorganisms. A diagnosis of hand-foot syndrome was made. After 2 weeks, the patient showed marked improvement and the plan was to restart sorafenib at a lower dosage.
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Affiliation(s)
- Jose Rodolfo Guerra
- Department of Medicine, Metropolitan Hospital Center/New York Medical College, New York, New York, USA
| | - Ana M Suelves
- Department of Medicine, Metropolitan Hospital Center/New York Medical College, New York, New York, USA
| | - Archie Bella
- Department of Medicine, Metropolitan Hospital Center/New York Medical College, New York, New York, USA
| | - Delatre Lolo
- Department of Medicine, Metropolitan Hospital Center/New York Medical College, New York, New York, USA
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13
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Corazza M, Minghetti S, Borghi A, Virgili A, Ballardini P. Hand-foot syndrome caused by docetaxel with no recurrence after switch to paclitaxel, a different taxane. Int J Dermatol 2013; 53:e180-2. [PMID: 23621794 DOI: 10.1111/j.1365-4632.2012.05782.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Monica Corazza
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Ferrara, Ferrara, Italy
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14
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15
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Donati A, Castro LGM. Cutaneous adverse reactions to chemotherapy with taxanes: the dermatologist's point of view. An Bras Dermatol 2012; 86:755-8. [PMID: 21987144 DOI: 10.1590/s0365-05962011000400020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 07/11/2010] [Indexed: 12/12/2022] Open
Abstract
Chemotherapy with taxanes has recently become part of the treatment for many advanced neoplastic diseases, specially breast and lung cancer. Their main noncutaneous adverse reactions include neutropenia and mucositis, which eventually lead to drug discontinuation. Cutaneous adverse reactions are frequent and significantly interfere with the patient's quality of life. Treatments are poorly effective, but special recommendations may improve symptoms and prevent relapses requiring drug rechallenge.
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Affiliation(s)
- Aline Donati
- Check-up Service of Fleury Laboratory, São Paulo, Brazil
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16
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Clark AS, Vahdat LT. Chemotherapy-induced palmar-plantar erythrodysesthesia syndrome: etiology and emerging therapies. ACTA ACUST UNITED AC 2011; 1:213-8. [PMID: 18628145 DOI: 10.3816/sct.2004.n.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Palmar-plantar erythrodysesthesia, or hand-foot syndrome (HFS), is emerging as a common, dose-dependent toxicity of many newer chemotherapy drugs. Frequently, HFS is a dose-limiting toxicity requiring discontinuation of treatment, chemotherapy dose reductions, or delays. The spectrum of symptoms of HFS can be mild, with erythema of the distal extremities, or it can be severe enough to interfere with activities of daily living. Although the exact mechanism is unknown, there are several approaches to ameliorating the symptoms of this complication. These include antiinflammatory agents, vitamin products, and peripheral vasoconstricting agents.
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Affiliation(s)
- Amy S Clark
- Division of Hematology/Medical Oncology, Weill Medical College of Cornell University, New York
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Kang YK, Lee SS, Yoon DH, Lee SY, Chun YJ, Kim MS, Ryu MH, Chang HM, Lee JL, Kim TW. Pyridoxine Is Not Effective to Prevent Hand-Foot Syndrome Associated With Capecitabine Therapy: Results of a Randomized, Double-Blind, Placebo-Controlled Study. J Clin Oncol 2010; 28:3824-9. [DOI: 10.1200/jco.2010.29.1807] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine whether concurrent pyridoxine therapy can prevent the development of hand-foot syndrome (HFS) in patients being treated with capecitabine. Methods Chemotherapy-naive patients with GI tract cancers scheduled for capecitabine-containing chemotherapy were randomly assigned to concurrent oral pyridoxine (200 mg/d) or placebo. Patients were stratified by chemotherapy regimen and monitored until development of National Cancer Institute Common Toxicity Criteria grade 2 or worse HFS or capecitabine-containing chemotherapy ended. Patients in the placebo group who developed grade 2 or worse HFS were randomly assigned again to receive pyridoxine or placebo in the next chemotherapy cycle to determine whether pyridoxine could improve HFS. Results The median number of chemotherapy cycles to grade 2 or worse HFS was three in both groups. Grade 2 or worse HFS developed in 55 (30.6%) of 180 placebo-treated patients and in 57 (31.7%) of 180 pyridoxine patients. The cumulative dose of capecitabine to grade 2 or worse HFS was not different between the two groups (median not reached in either group; hazard ratio [HR] = 0.95; P = .788). Randomization of the 44 patients in the placebo group with grade 2 or worse HFS to placebo or pyridoxine for the next cycle resulted in no significant difference in the proportion showing improvement of HFS (42.9% v 47.8%; HR = 1.12; P = .94). By multivariate analysis, age ≥ 56 years (HR = 1.768; 95% CI, 1.190 to 2.628; P = .005) was an independent risk factor for grade 2 or worse HFS, and combined use of docetaxel (HR = 2.046; 95% CI, 0.880 to 4.755; P = .096) was of borderline significance. Conclusion Pyridoxine is not effective in prevention of capecitabine-associated HFS.
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Affiliation(s)
- Yoon-Koo Kang
- From the Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Sook Lee
- From the Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- From the Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Young Lee
- From the Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ju Chun
- From the Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Sun Kim
- From the Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Hee Ryu
- From the Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heung-Moon Chang
- From the Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Lyun Lee
- From the Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Won Kim
- From the Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sanches Junior JA, Brandt HRC, Moure ERD, Pereira GLS, Criado PR. Reações tegumentares adversas relacionadas aos agentes antineoplásicos: parte I. An Bras Dermatol 2010; 85:425-37. [DOI: 10.1590/s0365-05962010000400003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Indexed: 11/22/2022] Open
Abstract
O tratamento local e sistêmico das neoplasias pode causar alterações na pele, membranas mucosas, cabelos e unhas. O diagnóstico preciso e o tratamento adequado destes efeitos colaterais requerem conhecimento dos padrões das reações adversas mais comuns para as medicações que o paciente está utilizando. O dermatologista deve estar familiarizado com as manifestações tegumentares das neoplasias, bem como com os efeitos adversos mucocutâneos dos tratamentos antineoplásicos.
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Plantar erythrodysesthesia with bullous otitis externa, toxicities from sorafenib: a case report. CASES JOURNAL 2009. [DOI: 10.1186/1757-1626-0002-0000006264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Lung cancer is the leading cause of cancer death worldwide and the use of novel agents, such as sorafenib has now demonstrated activity in Non Small Cell Lung Cancer. We present a case of a 77-year-old Caucasian male with advanced adenocarcinoma of the lung, who was being treated on clinical trial with single agent sorafenib. After seven weeks of treatment the patient presented to clinic with difficulty walking. Physical exam revealed acral erythema with bollous formation on bilateral soles of his feet. Otoscopic exam revealed bilateral external canal bullous lesion. The patient was diagnosed with plantar erythrodysesthesia with bullous otitis externa, a new toxicities in patients being treated with sorafenib.
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20
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Plantar erythrodysesthesia with bullous otitis externa, toxicities from sorafenib: a case report. CASES JOURNAL 2009; 2:6264. [PMID: 19918567 PMCID: PMC2769277 DOI: 10.4076/1757-1626-2-6264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 07/27/2009] [Indexed: 11/08/2022]
Abstract
Lung cancer is the leading cause of cancer death worldwide and the use of novel agents, such as sorafenib has now demonstrated activity in Non Small Cell Lung Cancer. We present a case of a 77-year-old Caucasian male with advanced adenocarcinoma of the lung, who was being treated on clinical trial with single agent sorafenib. After seven weeks of treatment the patient presented to clinic with difficulty walking. Physical exam revealed acral erythema with bollous formation on bilateral soles of his feet. Otoscopic exam revealed bilateral external canal bullous lesion. The patient was diagnosed with plantar erythrodysesthesia with bullous otitis externa, a new toxicities in patients being treated with sorafenib.
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Sivaramamoorthy C, Thientosapol ES, Tattersall MH. Hand-foot syndrome after treatment with docetaxel. Med J Aust 2009; 191:40. [PMID: 19580538 DOI: 10.5694/j.1326-5377.2009.tb02675.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Accepted: 04/30/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Chitra Sivaramamoorthy
- Department of Medical Oncology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Kaya AO, Buyukberber S, Coskun U, Yildiz R, Ozturk B, Yaman E, Adisen E, Gureli M, Benekli M. Acute erythema and edematous skin reaction and ectropion following docetaxel in a patient with non-small cell lung cancer. Cutan Ocul Toxicol 2008; 27:327-31. [DOI: 10.1080/15569520802431369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Eccrine squamous syringometaplasia is a histologic finding associated with chemotherapy administration and other cutaneous diseases. Concentration of the chemotherapeutic agents is believed to effect toxic changes in these epithelial structures. We report the first case of vincristine-induced eccrine squamous syringometaplasia in a 12-year-old patient undergoing treatment for rhabdomyosarcoma.
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Affiliation(s)
- Lacey Mitchell Thomas
- Division of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-0028, USA.
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Affiliation(s)
- Mirna H Farhat
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
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Lacouture ME, Reilly LM, Gerami P, Guitart J. Hand foot skin reaction in cancer patients treated with the multikinase inhibitors sorafenib and sunitinib. Ann Oncol 2008; 19:1955-61. [PMID: 18550575 DOI: 10.1093/annonc/mdn389] [Citation(s) in RCA: 186] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study examined clinicopathological findings and management of hand foot skin reaction (HFSR) to sorafenib and sunitinib in a dermatology referral center for cancer-related toxic effects. PATIENTS AND METHODS We identified 12 patients who developed HFSR in a 1-year period (2007). Medical records and histological specimens were investigated for clinicopathological data and results on management. RESULTS We identified 12 patients developing HFSR on treatment with sorafenib (83%) or sunitinib (17%). Majority presented with grade 3 (75%) HFSR and a median Skindex score of 43. Biopsies in seven patients showed horizontal layers of keratinocyte necrosis, which correlated to time of drug exposure: early (<30 days from initiation) leading to stratum granulosum-spinosum alterations and late (> or =30 days) resulting in stratum corneum pathology. Treatment with topical urea singly (n = 3), plus tazarotene (n = 7), or fluorouracil (n = 2) resulted in > or =2 grade improvement in the majority of patients (58%), with five patients (42%) improving one grade (P = 0.007). Median Skindex score at follow-up was 32 (P = 0.22). CONCLUSIONS There are unique clinicopathological characteristics of HFSR due to the multikinase inhibitors that correlate with time of agent initiation. Treatment with topical agents having keratolytic, antiproliferative, and anti-inflammatory properties showed benefit.
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Affiliation(s)
- M E Lacouture
- Department of Dermatology, SERIES Clinic, Northwestern University's Feinberg School of Medicine, Chicago, IL 60611, USA.
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Heidary N, Naik H, Burgin S. Chemotherapeutic agents and the skin: An update. J Am Acad Dermatol 2008; 58:545-70. [PMID: 18342708 DOI: 10.1016/j.jaad.2008.01.001] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 01/07/2008] [Accepted: 01/10/2008] [Indexed: 12/17/2022]
Abstract
UNLABELLED Chemotherapeutic agents give rise to numerous well described adverse effects that may affect the skin, hair, mucous membranes, or nails. The mucocutaneous effects of longstanding agents have been extensively studied and reviewed. Over the last 2 decades, a number of new molecular entities for the treatment of cancer have been approved by the United States Food and Drug Administration (FDA). This article reviews the cutaneous toxicity patterns of these agents. It also reviews one drug that has not received FDA approval but is in use outside the United States and is important dermatologically. Particular emphasis is placed on the novel signal transduction inhibitors as well as on newer literature pertaining to previously described reactions. LEARNING OBJECTIVES At the completion of this learning activity, participants should able to list the newer chemotherapeutic agents that possess significant mucocutaneous side effects and describe the range of reactions that are seen with each drug. In addition, they should be able to formulate appropriate management strategies for these reactions.
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Affiliation(s)
- Noushin Heidary
- Ronald O. Perelman Department of Dermatology, New York University, New York, USA
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27
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Cutaneous Reactions to Chemotherapy: Commonly Seen, Less Described, Little Understood. Dermatol Clin 2008; 26:103-19, ix. [DOI: 10.1016/j.det.2007.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Beldner M, Jacobson M, Burges GE, Dewaay D, Maize JC, Chaudhary UB. Localized palmar-plantar epidermal hyperplasia: a previously undefined dermatologic toxicity to sorafenib. Oncologist 2007; 12:1178-82. [PMID: 17962611 DOI: 10.1634/theoncologist.12-10-1178] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The development of multitargeted tyrosine kinase inhibitors has provided significant advances in the treatment of renal cell carcinoma. This case describes initial therapy for managing renal cell cancer with the administration of sorafenib, a multitargeted tyrosine kinase inhibitor. We report the development of localized palmar-plantar epidermal hyperplasia, a rare but significant cutaneous adverse event from sorafenib therapy. Mild-to-moderate dermatologic toxicity from sorafenib has been well described in the literature. We also review the current knowledge and the proposed hypothesis for the development of cutaneous events related to tyrosine kinase inhibitors. This particular case represents a unique form of dermatologic toxicity to sorafenib that has not previously been described in the literature.
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Affiliation(s)
- Matthew Beldner
- Department of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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29
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Adachi A, Horikawa T. Paclitaxel-induced cutaneous lupus erythematosus in patients with serum anti-SSA/Ro antibody. J Dermatol 2007; 34:473-6. [PMID: 17584326 DOI: 10.1111/j.1346-8138.2007.00313.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Two women (aged 46 and 56 years) developed annular erythema on their sun-exposed skin, including their forearms and faces, after biweekly i.v. administration of paclitaxel for 3-4 months to treat breast cancer. Both cases showed interface changes of basal keratinocytes and high titers of serum anti-SSA/Ro antibody. The diagnoses of paclitaxel-induced cutaneous lupus erythematosus (LE) were made because the skin eruptions cleared rapidly within 3 weeks after the paclitaxel treatment was discontinued. Paclitaxel is proposed to be a causative agent that can provoke cutaneous LE.
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Affiliation(s)
- Atsuko Adachi
- Department of Dermatology, Hyogo Prefectural Kakogawa Hospital, Kakogawa, Japan.
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30
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Damasiewicz MJ, Chionh FJM, Hayes T. Severe palmar-plantar erythema in a patient with breast cancer receiving doxorubicin-cyclophosphamide chemotherapy. Intern Med J 2007; 37:505-6. [PMID: 17547732 DOI: 10.1111/j.1445-5994.2007.01380.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
A 72-year-old patient with esophageal carcinoma developed a severe hand-foot syndrome during second-line therapy with the oral fluoropyrimidine capecitabine. We also summarize the current knowledge with regard to the hand-foot syndrome and distinguish it from palmoplantar erythrodysesthesia.
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Affiliation(s)
- A Marini
- Hautklinik der Heinrich-Heine-Universität, Moorenstrasse 5, 40225 Düsseldorf
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32
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Sapp CM, DeSimone P. Palmar-plantar erythrodysesthesia associated with scrotal and penile involvement with capecitabine. Clin Colorectal Cancer 2007; 6:382-5. [PMID: 17311704 DOI: 10.3816/ccc.2007.n.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Capecitabine is an orally active fluoropyrimidine that has been approved for first-line treatment of metastatic colorectal cancer when fluoropyrimidines alone are indicated. One of the toxicities described in the literature associated with capecitabine is palmar-plantar erythrodysesthesia. Based on a careful review of the literature, no reported cases of erythema, ulceration, and swelling that involves the penis and scrotum have been described in association with capecitabine. The following 2 cases illustrate palmar-plantar erythrodysesthesia with scrotal and penile involvement secondary to capecitabine.
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Affiliation(s)
- Christy M Sapp
- University of Kentucky, Markey Cancer Center, Lexington, KY 40536-0093, USA
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33
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Lee CK, Lynch J. Hand-foot syndrome in breast cancer patients receiving adjuvant chemotherapy. Intern Med J 2007; 37:281-2. [PMID: 17388876 DOI: 10.1111/j.1445-5994.2007.01332.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Trabelsi S, Boussen H, Zaïem A, Aouam K, Aïdli SE, Loueslati MH, Lakhal M, Belkahia C. Syndrome main-pieds induit par la méthotrexate. Therapie 2007; 62:189-90. [DOI: 10.2515/therapie:2007017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 02/26/2007] [Indexed: 11/20/2022]
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Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Centre, Sehgal Nursing Home, Panchwati, Azadpur, Delhi, and Skin Institute and School of Dermatology, Greater Kailash, New Delhi, India.
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36
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Abstract
OBJECTIVE To review common cutaneous effects and dermatologic or cutaneous toxicities related to the administration of chemotherapy. These range from mostly cosmetic, such as hyperpigmentation or alopecia, to dose-limiting toxicities such as palmar-plantar erythrodysesthesia or hand-foot syndrome. DATA SOURCES Current research, published literature, and internet resources. CONCLUSION Assessment and grading of associated toxicities of therapy is an integral part of caring for this patient population. Early intervention may reduce toxicities associated with therapies for this patient population IMPLICATIONS FOR NURSING PRACTICE As more patients receive chemotherapy, dermatologic effects are becoming more common. Oncology nurses must be skilled in managing these side effects.
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Kara IO, Sahin B, Erkisi M. Palmar–plantar erythrodysesthesia due to docetaxel–capecitabine therapy is treated with vitamin E without dose reduction. Breast 2006; 15:414-24. [PMID: 16188440 DOI: 10.1016/j.breast.2005.07.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Revised: 04/14/2005] [Accepted: 07/04/2005] [Indexed: 12/27/2022] Open
Abstract
Palmar-plantar erythrodysesthesia (PPE) is a distinctive and relatively frequent toxic reaction related to some chemotherapeutic agents. Doxorubicin, cytarabine, docetaxel, fluorouracil, and capecitabine are the most frequently implicated agents. Recently, taxanes, especially docetaxel, have been widely used in combination with capecitabine in patients with metastatic breast cancer (MBC). A high percentage of PPE has been seen in patients undergoing this combination therapy. PPE seems to be dose dependent and both peak drug concentration and total cumulative dose determine its occurrence. Withdrawal or dose reduction of the implicated drug usually gives rise to amelioration of the symptoms. Supportive treatments such as topical wound care, elevation, and cold compresses may help to relieve the pain. Use of systemic corticosteroids, pyridoxine (vitamin B6), blood flow reduction, and, recently, topical 99% dimethyl-sulfoxide have been used with variable outcomes. Vitamin E treatment has not been published before, especially without dose reduction of docetaxel-capecitabine therapy. Here we present five MBC patients treated with docetaxel-capecitabine combination therapy in whom PPE was observed during the clinical follow-up period. In all patients grade 2-3 PPE was observed. Vitamin E therapy was started at 300 mg/day p.o. without dose reduction of therapy and after 1 week of treatment PPE began to disappear. We suggest that it could be of interest to consider vitamin E as a preventive drug when drugs with a strong association with PPE are going to be administered.
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Affiliation(s)
- Ismail Oguz Kara
- Department of Medical Oncology, Faculty of Medicine, Cukurova University, Balcali Hospital, 01330 Yuregir-Adana, Turkey.
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Abstract
Due to its high metabolic rate, skin represents one of the major target organs of chemotherapy-associated toxicity. Reactions range from common, nonspecific exanthematous eruptions to rare but distinctive cutaneous lesions that may not become apparent until a drug transitions from clinical trials to widespread oncologic use. The challenge of the physician is to recognize reaction patterns that reflect a drug reaction, identify a likely causative drug, and determine whether the reaction is a dose-limiting toxicity. This review will focus on the cutaneous side effects of the newer classes of chemotherapy drugs, including targeted monoclonal antibody therapy and small molecule inhibitors.
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Affiliation(s)
- Aimee S Payne
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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39
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Meller S, Reifenberger J, Stege H, Ruzicka T, Homey B. [Palmoplantar erythrodysesthesia after intravenous therapy with docetaxel]. Hautarzt 2005; 56:965-6. [PMID: 16142497 DOI: 10.1007/s00105-005-1024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S Meller
- Hautklinik der Heinrich-Heine-Universität Düsseldorf
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40
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Schwartz J, Domchek SM, Hwang WT, Fox K. Evaluation of anemia, neutropenia and skin toxicities in standard or dose-dense doxorubicin/cyclophosphamide (AC)–paclitaxel or docetaxel adjuvant chemotherapy in breast cancer. Ann Oncol 2005; 16:247-52. [PMID: 15668278 DOI: 10.1093/annonc/mdi058] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Results of CALGB 9741 demonstrated that administering standard doxorubicin/cyclophosphamide (AC)-paclitaxel therapy for adjuvant therapy of breast cancer in a dose-dense fashion with colony-stimulating factors increases efficacy, decreases severe neutropenia, but may increase the need for blood transfusions. A chart review was performed to evaluate the rates of anemia, neutropenia and skin toxicities with dose-dense and traditional AC-taxane chemotherapy. PATIENTS AND METHODS A total of 112 patients received one of four treatments: non-dose-dense AC-paclitaxel (NDD Pac), dose-dense AC-paclitaxel (DD Pac), non dose-dense AC-docetaxel (NDD Doc), or dose-dense AC-docetaxel (DD Doc). RESULTS Transfusion rates were not increased in the dose-dense population; however, rates of grade 2-4 anemia (23% versus 0%, P=0.029), as well as erythropoietin use (58% versus 0%, P <0.0001), were significantly increased in the DD Pac group compared with the NDD Pac group. Grade 3 skin toxicities were significantly increased in the DD Doc group compared with the NDD Doc group (70% versus 11%, P <0.0001). CONCLUSIONS These results demonstrate that dose-dense AC-taxane therapy may increase rates of anemia and the need for erythropoietin, and decrease rates of neutropenia. The utility of DD Doc appears limited by skin toxicities and its use outside of a clinical study should not be recommended.
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Affiliation(s)
- J Schwartz
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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41
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Affiliation(s)
- Patricia Tinio
- Department of Dermatology, The Mount Sinai Medical Center, New York, New York 10029, USA
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42
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Heo YS, Chang HM, Kim TW, Ryu MH, Ahn JH, Kim SB, Lee JS, Kim WK, Cho HK, Kang YK. Hand-foot syndrome in patients treated with capecitabine-containing combination chemotherapy. J Clin Pharmacol 2005; 44:1166-72. [PMID: 15342618 DOI: 10.1177/0091270004268321] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical characteristics and risk factors of hand-foot syndrome were investigated in patients who received capecitabine-containing chemotherapy. Toxicity data were analyzed from 179 patients in 4 prospective clinical trials testing docetaxel/capecitabine/cisplatin in stomach cancer, capecitabine/cisplatin in biliary or stomach cancer, and vinorelbine/capecitabine in breast cancer. Hand-foot syndrome was reported in 116/179 (64.8%) of patients, with grade 3 hand-foot syndrome in 8/179 (4.5%). Hand-foot syndrome first developed within the first 3 chemotherapy cycles in 100/116 (86.2%) patients, with the median onset for all 3 treatment regimens occurring during cycle 2. Because severe reactions were rare, hand-foot syndrome was not a major factor influencing treatment schedule. Risk factor analyses showed that combined use of docetaxel and preceding chemotherapy-related stomatitis were significant risk factors for the development of hand-foot syndrome. Our results suggest that a combined treatment agent and a patient's susceptibility to chemotherapy-related toxicity may increase the risk of capecitabine-induced hand-foot syndrome.
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Affiliation(s)
- Young Seol Heo
- Department of Pharmacy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Moisidis C, Möbus V. Erythema multiforme major following docetaxel. Arch Gynecol Obstet 2004; 271:267-9. [PMID: 15243755 DOI: 10.1007/s00404-004-0643-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2003] [Accepted: 04/13/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective was to report a severe skin reaction, erythema multiforme major, following administration of docetaxel. CASE SUMMARY A female patient receiving weekly docetaxel for metastatic breast cancer developed a severe skin reaction characterized by blistering target lesions on her upper and lower extremities as well as painful ulcers of her oropharynx. The diagnosis of erythema multiforme major was made and high-dose hydrocortisone began, with gradual resolution of her symptoms. DISCUSSION The semi-synthetic taxoid docetaxel, which is increasingly being used in the treatment of breast cancer, has been associated with several adverse skin reactions, including hypersensitivity, nail pigmentation, nail onycholysis, erythrodysethesia, and scleroderma. We report the first case of erythema multiforme major (Stevens-Johnson syndrome) following docetaxel. Erythema multiforme major is a rare inflammatory skin disease associated with certain drugs (i.e., sulfonamides, non-steroidal anti-inflammatory agents, anticonvulsants). It is characterized by a distinguishing target skin lesion and ulceration of mucosal surfaces. In severe cases, systemic manifestations such as pneumonitis can also occur. Treatment involves use of moderate to high-dose corticosteroids. SUMMARY Clinicians using docetaxel should be aware of the variety of skin reactions that can occur, how they can be avoided and their severity reduced. Severe skin reactions such as occurred with our patient should be recognized and treated promptly in consultation with a dermatologist.
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Affiliation(s)
- Christina Moisidis
- Department of Obstetrics and Gynecology, Städtische Kliniken Frankfurt-Hoechst, Gotenstrasse 6-8, 65929 Frankfurt, Germany.
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