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Molecular targets and therapeutics in chemoresistance of triple-negative breast cancer. Med Oncol 2021; 39:14. [PMID: 34812991 DOI: 10.1007/s12032-021-01610-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/03/2021] [Indexed: 02/06/2023]
Abstract
Triple-negative breast cancer (TNBC) is a specific subtype of breast cancer (BC), which shows immunohistochemically negative expression of hormone receptor i.e., Estrogen receptor and Progesterone receptor along with the absence of Human Epidermal Growth Factor Receptor-2 (HER2/neu). In Indian scenario the prevalence of BC is 26.3%, whereas, in West Bengal the cases are of 18.4%. But the rate of TNBC has increased up to 31% and shows 27% of total BC. Conventional chemotherapy is effective only in the initial stages but with progression of the disease the effectivity gets reduced and shown almost no effect in later or advanced stages of TNBC. Thus, TNBC patients frequently develop resistance and metastasis, due to its peculiar triple-negative nature most of the hormonal therapies also fails. Development of chemoresistance may involve various factors, such as, TNBC heterogeneity, cancer stem cells (CSCs), signaling pathway deregulation, DNA repair mechanism, hypoxia, and other molecular factors. To overcome the challenges to treat TNBC various targets and molecules have been exploited including CSCs modulator, drug efflux transporters, hypoxic factors, apoptotic proteins, and regulatory signaling pathways. Moreover, to improve the targets and efficacy of treatments researchers are emphasizing on targeted therapy for TNBC. In this review, an effort has been made to focus on phenotypic and molecular variations in TNBC along with the role of conventional as well as newly identified pathways and strategies to overcome challenge of chemoresistance.
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A pilot randomized double-blind, placebo-controlled study on the effects of the topical application of pyridoxine on palmar-plantar erythrodysesthesia (PPE) induced by capecitabine or pegylated liposomal doxorubicin (PLD). Eur J Oncol Nurs 2021; 50:101866. [DOI: 10.1016/j.ejon.2020.101866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/26/2022]
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3
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Park JY. Analysis of data on capecitabine-related adverse drug reactions from the Korean adverse event reporting system database. Eur J Oncol Nurs 2018; 34:55-60. [DOI: 10.1016/j.ejon.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 01/15/2023]
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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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Lademann J, Röwert-Huber HJ, Haas N, Kluschke F, Patzelt A, Zastrow L, Lange-Asschenfeldt B, Jung S, Sterry W, Sehouli J. Palmoplantar erythrodysesthesia-like skin symptoms in patients under various chemotherapeutics: preventive and therapeutic options. Skin Pharmacol Physiol 2014; 27:229-33. [PMID: 24802288 DOI: 10.1159/000356780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/25/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The palmoplantar erythrodysaesthesia (PPE) is an inflammatory cutaneous side effect in patients under chemotherapy with pegylated liposomal doxorubicin (PLD), with indications that also other chemotherapeutics induce similar side effects. Recently, it has been demonstrated that PLD escapes with the sweat onto the skin inducing radical-forming processes that damage the skin. The topical application of antioxidants with a high radical protection factor has proven to be a very efficient prevention strategy for PLD-treated patients. METHODS 68 patients, who had been treated with 12 different chemotherapeutics and experienced side effects similar to PPE, were treated with a meanwhile commercially available ointment. RESULTS At the beginning of the therapy, 46 patients suffered from a PPE of severity grade III, while in 22 patients a PPE of severity grade II was diagnosed. The application of the ointment resulted in a significant improvement of the clinical symptoms and the skin status in all these patients; their chemotherapies could be continued. CONCLUSION The obtained results suggest that radical-forming processes play an essential role in a great number of chemotherapeutics which induce dermal side effects. The topical application of the antioxidant-containing ointment proved to be a good therapeutic option which needs further evaluation.
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Affiliation(s)
- Juergen Lademann
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Ozkol HU, Calka O, Bulut G. Chemotherapy-induced acral erythema with involvement of the face and neck: A case report. Toxicol Ind Health 2013; 32:791-4. [PMID: 24311625 DOI: 10.1177/0748233713511514] [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: 12/27/2022]
Abstract
Chemotherapy-induced acral erythema (CIAE) is a cutaneous response to diverse chemotherapeutic drug administration. These drugs cause symmetrical and painful erythema of palmoplantar surfaces. Bulla formation, desquamation, and subsequent reepithelialization may occur. Commonly, the lesions slowly resolve over 7-15 days, through desquamation, followed by regeneration of the skin. Here, we described a case of CIAE, with involvement of face and neck in a patient treated for breast cancer using a number of chemotherapeutic agents. Face involvement in CIAE has not been previously reported in the literature.
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Affiliation(s)
- Hatice Uce Ozkol
- Department of Dermatology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Omer Calka
- Department of Dermatology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Gulay Bulut
- Department of Pathology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
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Bano N, Najam R, Mateen A. Comparative Assessment of Skin and Subcutaneous Toxicity in Patients of Advanced Colorectal Carcinoma Treated with Different Schedules of FOLFOX. Asian Pac J Cancer Prev 2013; 14:1781-6. [DOI: 10.7314/apjcp.2013.14.3.1781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Son HS, Lee WY, Lee WS, Yun SH, Chun HK. Compliance and effective management of the hand-foot syndrome in colon cancer patients receiving capecitabine as adjuvant chemotherapy. Yonsei Med J 2009; 50:796-802. [PMID: 20046420 PMCID: PMC2796406 DOI: 10.3349/ymj.2009.50.6.796] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 01/30/2009] [Accepted: 01/30/2009] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Physicians and oncology nurses must continue to update their knowledge on treatment and treatment-related side effects, while searching for effective methods to prevent or manage side effects. The objective of our study was to describe the incidence and response to treatment of the hand-foot syndrome (HFS) and the compliance with treatment of patients with stage IIB, IIIA, IIIB, and IIIC colon cancer that were treated with capecitabine alone as adjuvant therapy. MATERIALS AND METHODS Between September 2005 and September 2006, 84 patients fulfilled the inclusion criteria and were included in this retrospective analysis of prospectively collected data. RESULTS The treatment compliance rate was 90.5% (76 out of the 84 patients). The HFS developed in 65 patients (77.4%). Thirty-three patients (50.7%) had grade 1 HFS, 22 patients (33.8%) had grade 2 HFS and 10 patients (15.5%) had grade 3 HFS, as their most severe episode. For Grade 1 patients, the dose was maintained, and skin barrier cream and moist exposed burn ointment (MEBO) were applied. For Grade 2 patients, either the dose was maintained or 25% of the dose was reduced; MEBO and supportive care were provided. For Grade 3 patients, one cycle of chemotherapy was interrupted followed by dose adjustment; MEBO and supportive care were provided. CONCLUSION HFS is manageable if both patients and oncology care teams are educated about HFS associated with capecitabine. The HFS is treated by patient education, preventive management, ointment application, conservative management, dose reduction, and interruption of chemotherapy administration.
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Affiliation(s)
- Hyun-Sook Son
- Department of Nursing, Colorectal Cancer Center, Samsung Medical Center, Seoul, Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Suk Lee
- Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science, Inchon, Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho-Kyung Chun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee SH, Noh SH, Kim SY, Jang KY, Hwang PH. Hand-Foot syndrome induced by sorafenib, a multitargeted tyrosine kinase inhibitor, in a patient with advanced renal cell carcinoma. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.1.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Seung Hyun Lee
- Department of Pediatrics, Chonbuk National University, Jeonju, Korea
| | - Sung Hun Noh
- Department of Pediatrics, Chonbuk National University, Jeonju, Korea
| | - Sun Young Kim
- Department of Pediatrics, Chonbuk National University, Jeonju, Korea
| | - Kyu Yun Jang
- Department of Pathology, Research Institute of Clinical Medicine School of Medicine, Chonbuk National University, Jeonju, Korea
| | - Pyoung Han Hwang
- Department of Pediatrics, Chonbuk National University, Jeonju, Korea
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Chu D, Lacouture ME, Fillos T, Wu S. Risk of hand-foot skin reaction with sorafenib: a systematic review and meta-analysis. Acta Oncol 2008; 47:176-86. [PMID: 18210295 DOI: 10.1080/02841860701765675] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hand-foot skin reaction (HFSR) is a dose-limiting toxicity associated with sorafenib, an oral multi-kinase inhibitor with clinical activity against solid tumors. This study was conducted to determine the risk of developing HFSR among patients receiving sorafenib. PATIENTS AND METHODS Databases from Pubmed, Web of Science, and abstracts presented at the American Society of Clinical Oncology annual meetings from 2004 through July, 2007 were searched to identify relevant studies. Eligible studies were prospective clinical trials using single agent sorafenib. The summary incidence rate and the relative risk (RR) were calculated using random-effects model. RESULTS A total of 4 883 patients in 11 trials with metastatic tumors were included for analysis. Among patients receiving sorafenib, the summary incidence of all-grade HFSR was 33.8% (95% CI: 24.5-44.7%) with significant difference between patients with RCC and non-RCC malignancy (RR 1.52, 95% CI: 1.32-1.75%, p<0.001). The incidence of high-grade HFSR was 8.9% (95% CI: 7.3-10.7%). In addition, sorafenib was associated with a significant increased risk of HFSR with RR of 6.6 (95% CI: 3.7 to 11.7, p<0.001) in comparison with controls. CONCLUSION There is a significant risk of HFSR associated with sorafenib. Proper management and further study are recommended to reduce the risk.
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von Moos R, Thuerlimann BJK, Aapro M, Rayson D, Harrold K, Sehouli J, Scotte F, Lorusso D, Dummer R, Lacouture ME, Lademann J, Hauschild A. Pegylated liposomal doxorubicin-associated hand–foot syndrome: Recommendations of an international panel of experts. Eur J Cancer 2008; 44:781-90. [PMID: 18331788 DOI: 10.1016/j.ejca.2008.01.028] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 01/28/2008] [Indexed: 12/12/2022]
Affiliation(s)
- Roger von Moos
- Medical Oncology, Kantonsspital Graubünden, Loestrasse 170, Chur 7000, Switzerland.
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Yucel I, Guzin G. Topical henna for capecitabine induced hand-foot syndrome. Invest New Drugs 2007; 26:189-92. [PMID: 17885735 DOI: 10.1007/s10637-007-9082-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 08/20/2007] [Indexed: 10/22/2022]
Abstract
Capecitabine is a chemotherapeutic drug for use in cancers. Hand-foot syndrome (HFS) is side effect of capecitabine which can lead the cessation of the therapy or dose reduction. Henna (Lawsonia inermis) is a traditionally used plant of Middle-East that is applied on hands and feet. Some of cancer patients in capecitabine treatment who developed HFS, we recommended to apply henna. In these patients, six patients were grade 3 HFS and four were grade 2 HFS. Complete response (CR) were seen in four of grade 3 HFS and all of grade 2; two grade 3 HFS improved to grade 1. So far, in the chemotherapy, there was no need of dose reduction and also no side effect of henna seen. Clinical improvement in these patients may relate to anti-inflammatory, antipyretic and analgesic effects of henna. Prospective studies are needed to show this therapeutic effect of henna.
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Affiliation(s)
- Idris Yucel
- Department of Medical Oncology, Ondokuz Mayis University Medical School, Samsun 55139, Turkey
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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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Webster-Gandy JD, How C, Harrold K. Palmar-plantar erythrodysesthesia (PPE): a literature review with commentary on experience in a cancer centre. Eur J Oncol Nurs 2007; 11:238-46. [PMID: 17350337 DOI: 10.1016/j.ejon.2006.10.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Revised: 09/27/2006] [Accepted: 10/03/2006] [Indexed: 12/23/2022]
Abstract
Palmar-plantar erythrodysesthesia (PPE) or hand-foot syndrome (HFS) is a relatively common side effect of cytotoxic chemotherapy. Many cytotoxic drugs have been reported to cause the condition but it is more frequently associated with 5 fluorouracil (5FU), liposomal doxorubicin and cytarabine. The oral 5FU precursor, capecitabine is frequently associated with PPE and with the recent extension of its use to adjuvant treatment, the incidence of PPE is likely to increase. The initial symptoms are dysesthesia and tingling in the palms, fingers and soles of feet and erythema, which may progress to burning pain with dryness, cracking, desquamation, ulceration and oedema. Palms of the hands are more frequently affected than soles of the feet. This condition is painful and distressing to patients and in some incidences it results in patients not being able to work or perform normal daily activities. It can also result in treatment interruptions which impact on the efficacy of the treatment regimen. Effective and appropriate patient education from a specialist nurse prior to treatment is an essential part of patient management which will facilitate early identification of the symptoms and therefore prevent treatment delays and PPE progression. This article reviews current knowledge of the condition, including classification, and discussion of the findings of a clinical audit in a cancer centre. It includes the incidence, grading, management and impact of PPE on normal daily activities.
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Affiliation(s)
- Joan D Webster-Gandy
- Faculty of Society and Health and Research Centre for Society and Health, Buckinghamshire Chilterns University College, Gorelands Lane, Chalfont St. Giles, Bucks HP8 4AD, UK.
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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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Stubblefield MD, Custodio CM, Kaufmann P, Dickler MN. Small-Fiber Neuropathy Associated with Capecitabine (Xeloda)-induced Hand-foot Syndrome: A Case Report. J Clin Neuromuscul Dis 2006; 7:128-132. [PMID: 19078798 DOI: 10.1097/01.cnd.0000211401.19995.a2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hand-foot syndrome commonly results from treatment with capecitabine and is associated with pain, dysesthesias, paresthesias, and temperature intolerance. The cause of these symptoms in hand-foot syndrome has not been determined. We present the clinical, electrophysiologic, and biopsy data from a patient with capecitabine-induced hand-foot syndrome as supporting evidence implicating small-fiber neuropathy as the cause of these neuropathic symptoms. A patient with stage 4 breast cancer who develops capecitabine-induced hand-foot syndrome is referred for clinical and electrophysiologic testing. Intraepidermal nerve fiber density is assessed. Clinical evaluation demonstrates markedly decreased pain and temperature sensation with preserved strength, proprioception, and light touch. Standard electrodiagnostic testing is normal. The assessment of epidermal nerve fiber density demonstrates marked small-fiber loss both proximally and distally. In conclusion, small-fiber neuropathy is a likely cause of the neuropathic symptoms encountered in capecitabine-induced hand-foot syndrome. Similar clinical, electrophysiologic, and pathologic assessments are needed to confirm this finding in larger populations.
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Affiliation(s)
- Michael D Stubblefield
- *Department of Neurology, Memorial Sloan-Kettering Cancer Center, Rehabilitation Medicine Service daggerDepartment of Neurology, New York-Presbyterian Hospital, Neurological Institute double daggerMemorial Sloan-Kettering Cancer Center, Breast Cancer Medicine Service, New York City, NY
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Lassere Y, Hoff P. Management of hand-foot syndrome in patients treated with capecitabine (Xeloda). Eur J Oncol Nurs 2004; 8 Suppl 1:S31-40. [PMID: 15341880 DOI: 10.1016/j.ejon.2004.06.007] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Comparative trials of capecitabine (Xeloda) versus 5-FU/LV in metastatic colorectal cancer have shown that hand-foot syndrome (HFS) was the only clinical adverse event occurring more frequently with capecitabine. Most patients with HFS present with dysesthesia, usually with a tingling sensation in the palms and soles of the hands and feet. This can progress in 3-4 days to burning pain plus well-defined symmetric swelling and erythema. The hands tend to be more commonly affected than the feet, and might even be the only area affected in some patients. HFS can interfere with the general activities of daily living, especially when blistering, moist desquamation, severe pain or ulceration occurs. While HFS is manageable, if ignored it can progress rapidly. However, dose interruption and reduction of capecitabine usually leads to a rapid reversal of signs and symptoms without long-term consequences. Nurses play a key role in educating patients how to recognise HFS, when to interrupt treatment and how to adjust the dose to maintain effective therapy with capecitabine over the long term. It is particularly important that patients and nurses are aware that dose interruption/reduction does not affect the overall antitumour efficacy of capecitabine.
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Affiliation(s)
- Yvonne Lassere
- Clinical Protocol Administration, MD Anderson Cancer Center, 1515 Holcombe Unit 426, Houston, TX 77030, USA.
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Marsé H, Van Cutsem E, Grothey A, Valverde S. Management of adverse events and other practical considerations in patients receiving capecitabine (Xeloda®). Eur J Oncol Nurs 2004; 8 Suppl 1:S16-30. [PMID: 15341879 DOI: 10.1016/j.ejon.2004.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
As capecitabine (Xeloda) is converted to 5-FU within tumours it can produce 5-FU-like side effects. However, diarrhoea, stomatitis, nausea, alopecia and neutropenia are significantly less frequent than with i.v. 5-FU. Hand-foot syndrome (HFS) is the only clinical adverse event occurring more often during capecitabine treatment. These findings in MCRC have also been confirmed in a large phase III trial in early stage colon cancer (X-Act adjuvant study) and phase II clinical trials in metastatic breast cancer. Because capecitabine is taken in the outpatient setting, the nurse and/or supervising clinician are responsible for educating patients how to use it correctly and on the nature/recognition/severity of adverse events. Patients need to be aware that temporary interruptions/dose modifications do not reduce the overall efficacy of capecitabine and will most likely lead to a resolution of side effects. Consequently, oncology nurses will be assuming a more significant and pivotal role in the efficient education and support of patients during home-based therapy with capecitabine.
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Affiliation(s)
- Hilde Marsé
- University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
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