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Iimura Y, Furukawa N, Ishibashi M, Ahiko Y, Tanabe T, Aikou S, Shida D, Nojima M, Kuroda S, Boku N. Study protocol of a single-arm phase 2 study evaluating the preventive effect of topical hydrocortisone for capecitabine-induced hand-foot syndrome in colorectal cancer patients receiving adjuvant chemotherapy with capecitabine plus oxaliplatin (T-CRACC study). BMC Gastroenterol 2022; 22:341. [PMID: 35836104 PMCID: PMC9284769 DOI: 10.1186/s12876-022-02411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS Clinical evidence of the preventive effectiveness of medium-class topical corticosteroids for capecitabine-induced hand foot syndrome (HFS) is limited. Although the pathogenesis and mechanism of HFS are unclear, inflammatory reactions are thought to be involved in HFS development. This study aimed to evaluate the preventive effect of medium-class topical corticosteroids (hydrocortisone butyrate 0.1% topical therapy) for capecitabine-induced HFS in patients with colorectal cancer receiving adjuvant chemotherapy with capecitabine plus oxaliplatin. METHODS This is a single-center, single-arm, phase 2 study. Patients with colorectal cancer scheduled to receive adjuvant chemotherapy with capecitabine plus oxaliplatin are enrolled, and topical hydrocortisone butyrate 0.1% is applied prophylactically in addition to standard moisturizing therapy. The primary endpoint is the incidence of grade ≥ 2 HFS within three months. The secondary endpoints are the time to onset of HFS, rates of dose reduction, schedule delay, discontinuation caused by capecitabine-induced HFS, and other adverse events. All adverse events are evaluated by clinical pharmacists and attending physicians. DISCUSSION This study is expected to contribute to the establishment of new supportive care for preventing HFS, not only for colorectal cancer patients receiving adjuvant chemotherapy, but also for various cancer patients receiving capecitabine-based chemotherapy. TRIAL REGISTRATION This trial was registered in the Japan Registry of Clinical Trials (jRCT) as jRCTs031220002. Registered 5 April 2022, https://jrct.niph.go.jp/search Protocol version V.1.0, 16 February 2022.
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Affiliation(s)
- Yohei Iimura
- Department of Pharmacy, The IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.
| | - Naoki Furukawa
- Department of Pharmacy, The IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Masaaki Ishibashi
- Department of Pharmacy, The IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Yuka Ahiko
- Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.,The Department of Surgery, The IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Taro Tanabe
- Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.,The Department of Surgery, The IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Susumu Aikou
- Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.,The Department of Surgery, The IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Dai Shida
- Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.,The Department of Surgery, The IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Masanori Nojima
- Center for Translational Research, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Seiichiro Kuroda
- Department of Pharmacy, The IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Narikazu Boku
- Department of Oncology and General Medicine, The Institute of Medical Science Hospital, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
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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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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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Kayikci EE, Can G, Sen F, Saip P. Henna Application in the Prevention of Capecitabine-Induced Hand-Foot Syndrome in Breast and Colorectal Cancer Patients. FLORENCE NIGHTINGALE JOURNAL OF NURSING 2020; 28:299-311. [PMID: 34263209 PMCID: PMC8134011 DOI: 10.5152/fnjn.2020.19097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/13/2019] [Indexed: 01/12/2023]
Abstract
AIM This study investigates the prophylactic effect of henna on the occurrence of hand-foot syndrome (HFS) in patients receiving capecitabine for breast and colorectal cancer. METHOD This experimental study was carried out between May 2014 and May 2015. In this self-control experimental study, 52 patients with breast and colorectal cancer were included on the first day of capecitabine treatment and had a minimum follow-up of 3 cycles. One hand/foot of each patient constituted the study hand/foot, whereas the others constituted the control. Henna was administered to the study hand/foot on the first day of treatment and application renewed weekly. Development of grade 1-3 toxicity was set as the termination criterion for study. RESULTS Painful skin changes such as rawness, intumescence and bulla formation, blocking the daily activities or self-care were observed in 26.9% of the patients in the 3rd or 4th cycles of treatment. Development time and severity of skin changes over time did not differ significantly between the study and the control hand/foot. CONCLUSION Further studies with a larger sample size are needed to conclude on the prophylactic effect of henna in the management of the HFS.
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Affiliation(s)
- Emel Emine Kayikci
- Department of Internal Medicine Nursing, İstanbul Medeniyet University Faculty of Health Sciences, Nursing Department, İstanbul, Turkey
| | - Gulbeyaz Can
- Department of Internal Medicine Nursing, İstanbul University-Cerrahpasa Florence Nightingale Faculty of Nursing, İstanbul, Turkey
| | - Fatma Sen
- Department of Medical Oncology, International Avrasya Hospital, İstanbul, Turkey
| | - Pınar Saip
- Department of Medical Oncology, İstanbul University, Institute of Oncology, İstanbul, Turkey
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Efficacy of oral administration of cystine and theanine in colorectal cancer patients undergoing capecitabine-based adjuvant chemotherapy after surgery: a multi-institutional, randomized, double-blinded, placebo-controlled, phase II trial (JORTC-CAM03). Support Care Cancer 2019; 28:3649-3657. [PMID: 31811480 PMCID: PMC7316838 DOI: 10.1007/s00520-019-05205-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/22/2019] [Indexed: 12/01/2022]
Abstract
Purpose Capecitabine-based adjuvant chemotherapy for colorectal cancer patients often causes adverse events (AEs), such as diarrhea, stomatitis, anorexia, and hand-foot syndrome (HFS). Cystine and theanine were reported to attenuate some chemotherapy-associated AEs, and hence are also expected to attenuate capecitabine-induced AEs. Therefore, we aimed to investigate the safety and efficacy of cystine/theanine treatment in colorectal cancer patients undergoing capecitabine-based adjuvant chemotherapy after surgery. Methods A total of 100 colorectal cancer patients treated with capecitabine as an adjuvant chemotherapy after surgery were randomly allocated into the cystine/theanine group (n = 52) or the placebo group (n = 48). The primary endpoint was incidence rate of diarrhea of grade 1 or higher in accordance with the Common Terminology Criteria for AEs (CTCAE) v.4.0, Japanese Clinical Oncology Group (JCOG) version. The secondary endpoints included incidence rates of other AEs (CTCAE v.4.0-JCOG), as well as the incidence rate of HFS according to the HFS grading scale. Results There were no significant differences in capecitabine-induced AEs between the two groups. However, the incidence rate of diarrhea of grade 1 or higher tended to be lower in the cystine/theanine group than the placebo group (18.4% vs. 28.9%, p = 0.169) as well as the incidence rate of HFS of grade 1 or higher (CTCAE v.4.0-JCOG or HFS grading scale) (67.4% vs. 77.8%, p = 0.185, 67.3% vs. 80.0%, p = 0.124, respectively). Conclusion This trial demonstrated that cystine/theanine treatment of colorectal cancer patients undergoing capecitabine-based adjuvant chemotherapy after surgery is safe and has the tendency to reduce the incidence rate of diarrhea or HFS. Trial registration UMIN000024784 Electronic supplementary material The online version of this article (10.1007/s00520-019-05205-1) contains supplementary material, which is available to authorized users.
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Hamaguchi R, Tsuchiya T, Miyata G, Sato T, Takahashi K, Ariyoshi K, Oyamada S, Iwase S. Efficacy of oral administration of cystine and theanine in patients with colorectal cancer undergoing capecitabine-based adjuvant chemotherapy after surgery: study protocol for a multi-institutional, randomised, double-blinded, placebo-controlled, phase II trial. BMJ Open 2018; 8:e021442. [PMID: 30030317 PMCID: PMC6059283 DOI: 10.1136/bmjopen-2017-021442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Although adjuvant capecitabine therapy for patients with colorectal cancer after surgery often causes adverse events (AEs), such as diarrhoea, stomatitis, anorexia and hand-foot syndrome (HFS), there are no standard prevention therapies. Cystine and theanine were reported to attenuate some chemotherapy-associated AEs, and are also expected to attenuate the AEs caused by capecitabine treatment. Therefore, our present study aimed to determine the safety and efficacy of cystine/theanine therapy in patients with colorectal cancer undergoing capecitabine-based adjuvant chemotherapy after surgery. METHODS AND ANALYSIS A multi-institutional, prospective, randomised, double-blinded, placebo-controlled, phase II trial is being planned. Patients with colorectal cancer treated with capecitabine as an adjuvant chemotherapy will be randomised into either the cystine/theanine group (n=50) or placebo group (n=50). Data will be collected during four courses of capecitabine therapy. The primary endpoint will be incidence rate of diarrhoea of grade 1 or higher in accordance with the Common Terminology Criteria for AEs (CTCAE) v.4.0, Japanese Clinical Oncology Group (JCOG) version. The secondary endpoints are incidence rates of other AEs (CTCAE v.4.0-JCOG), scores of the Japanese version of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire module for all patients with cancer (QLQ-C30) and for patients with colorectal cancer (QLQ-CR29), incidence rate of HFS according to the HFS grading scale, protocol adherence, completion rate of four courses of capecitabine therapy and the proportion of completion without delay or dose reduction, time to completion of four courses of capecitabine and total dose of capecitabine. A sample size of 100 patients will be analysed between November 2016 and April 2018. ETHICS AND DISSEMINATION Ethical approval was obtained at all participating institutions. The results of this study will be submitted for publication in international peer-reviewed journals. TRIAL REGISTRATION NUMBER UMIN000024784; Pre-results.
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Affiliation(s)
- Reo Hamaguchi
- Department of Palliative Medicine, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Takashi Tsuchiya
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, Sendai, Japan
| | - Go Miyata
- Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital, Iwate, Japan
| | - Toshihiko Sato
- Department of Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Kenichi Takahashi
- Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | - Keisuke Ariyoshi
- Department of Palliative Medicine, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Japanese Organisation for Research and Treatment of Cancer (JORTC), NPO, Tokyo, Japan
| | - Shunsuke Oyamada
- Japanese Organisation for Research and Treatment of Cancer (JORTC), NPO, Tokyo, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Hofheinz RD, Gencer D, Schulz H, Stahl M, Hegewisch-Becker S, Loeffler LM, Kronawitter U, Bolz G, Potenberg J, Tauchert F, Al-Batran SE, Schneeweiss A. Mapisal Versus Urea Cream as Prophylaxis for Capecitabine-Associated Hand-Foot Syndrome: A Randomized Phase III Trial of the AIO Quality of Life Working Group. J Clin Oncol 2015; 33:2444-9. [DOI: 10.1200/jco.2014.60.4587] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Hand-foot syndrome (HFS) is a frequently occurring adverse event associated with anticancer drugs. This study compares a newly introduced ointment containing several antioxidants and exhibiting high radical protection factor, which has been available on the German market since 2011, with urea cream for prevention of HFS in patients treated with capecitabine. Patients and Methods Patients with GI tumors or breast cancer treated with capecitabine were included in this randomized phase III study. The primary end point was prevention of HFS of any grade within 6 weeks of treatment as indicated by a standardized patient diary. The study had 80% power to show a 20% reduction of the incidence of HFS with the new ointment. Secondary end points included time to development of HFS greater than grade 1, evaluation of capecitabine dose intensity, and quality of life analyses. Results A total of 152 patients were evaluable. In total, 47 of 152 patients experienced HFS (30.9%), 39.5% with the new ointment and 22.4% in the urea arm (stratified odds ratio, 2.37; P = .02). Time to HFS greater than grade 1 was comparable, but time to any-grade HFS was significantly longer in the urea group (P = .03). Capecitabine dose intensity, time under study, and percentage of days with correct administration of study medication were identical, as were adverse events except for HFS. Skin-related quality of life was significantly worse in the group treated with the new ointment at the end of study treatment. Conclusion This trial demonstrated that 10% urea cream was superior to the new ointment at preventing HFS over the first 6 weeks of treatment with capecitabine.
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Affiliation(s)
- Ralf-Dieter Hofheinz
- Ralf-Dieter Hofheinz and Deniz Gencer, University Hospital Mannheim, Mannheim; Holger Schulz, Praxis Internistische Onkologie und Hämatologie, Frechen; Michael Stahl, Kliniken Essen-Mitte, Essen; Susanna Hegewisch-Becker, Hämatologisch-Onkologische Praxis Eppendorf, Hamburg; Luisa Mantovani Loeffler, Onkologie, Haematologie und Palliativmedizin, Leipzig; Ursula Kronawitter, Onkologische Schwerpunktpraxis, Traunstein; Georg Bolz, Medizinische Klinik I, Ludwigshafen; Jochem Potenberg, Waldkrankenhaus
| | - Deniz Gencer
- Ralf-Dieter Hofheinz and Deniz Gencer, University Hospital Mannheim, Mannheim; Holger Schulz, Praxis Internistische Onkologie und Hämatologie, Frechen; Michael Stahl, Kliniken Essen-Mitte, Essen; Susanna Hegewisch-Becker, Hämatologisch-Onkologische Praxis Eppendorf, Hamburg; Luisa Mantovani Loeffler, Onkologie, Haematologie und Palliativmedizin, Leipzig; Ursula Kronawitter, Onkologische Schwerpunktpraxis, Traunstein; Georg Bolz, Medizinische Klinik I, Ludwigshafen; Jochem Potenberg, Waldkrankenhaus
| | - Holger Schulz
- Ralf-Dieter Hofheinz and Deniz Gencer, University Hospital Mannheim, Mannheim; Holger Schulz, Praxis Internistische Onkologie und Hämatologie, Frechen; Michael Stahl, Kliniken Essen-Mitte, Essen; Susanna Hegewisch-Becker, Hämatologisch-Onkologische Praxis Eppendorf, Hamburg; Luisa Mantovani Loeffler, Onkologie, Haematologie und Palliativmedizin, Leipzig; Ursula Kronawitter, Onkologische Schwerpunktpraxis, Traunstein; Georg Bolz, Medizinische Klinik I, Ludwigshafen; Jochem Potenberg, Waldkrankenhaus
| | - Michael Stahl
- Ralf-Dieter Hofheinz and Deniz Gencer, University Hospital Mannheim, Mannheim; Holger Schulz, Praxis Internistische Onkologie und Hämatologie, Frechen; Michael Stahl, Kliniken Essen-Mitte, Essen; Susanna Hegewisch-Becker, Hämatologisch-Onkologische Praxis Eppendorf, Hamburg; Luisa Mantovani Loeffler, Onkologie, Haematologie und Palliativmedizin, Leipzig; Ursula Kronawitter, Onkologische Schwerpunktpraxis, Traunstein; Georg Bolz, Medizinische Klinik I, Ludwigshafen; Jochem Potenberg, Waldkrankenhaus
| | - Susanna Hegewisch-Becker
- Ralf-Dieter Hofheinz and Deniz Gencer, University Hospital Mannheim, Mannheim; Holger Schulz, Praxis Internistische Onkologie und Hämatologie, Frechen; Michael Stahl, Kliniken Essen-Mitte, Essen; Susanna Hegewisch-Becker, Hämatologisch-Onkologische Praxis Eppendorf, Hamburg; Luisa Mantovani Loeffler, Onkologie, Haematologie und Palliativmedizin, Leipzig; Ursula Kronawitter, Onkologische Schwerpunktpraxis, Traunstein; Georg Bolz, Medizinische Klinik I, Ludwigshafen; Jochem Potenberg, Waldkrankenhaus
| | - Luisa Mantovani Loeffler
- Ralf-Dieter Hofheinz and Deniz Gencer, University Hospital Mannheim, Mannheim; Holger Schulz, Praxis Internistische Onkologie und Hämatologie, Frechen; Michael Stahl, Kliniken Essen-Mitte, Essen; Susanna Hegewisch-Becker, Hämatologisch-Onkologische Praxis Eppendorf, Hamburg; Luisa Mantovani Loeffler, Onkologie, Haematologie und Palliativmedizin, Leipzig; Ursula Kronawitter, Onkologische Schwerpunktpraxis, Traunstein; Georg Bolz, Medizinische Klinik I, Ludwigshafen; Jochem Potenberg, Waldkrankenhaus
| | - Ursula Kronawitter
- Ralf-Dieter Hofheinz and Deniz Gencer, University Hospital Mannheim, Mannheim; Holger Schulz, Praxis Internistische Onkologie und Hämatologie, Frechen; Michael Stahl, Kliniken Essen-Mitte, Essen; Susanna Hegewisch-Becker, Hämatologisch-Onkologische Praxis Eppendorf, Hamburg; Luisa Mantovani Loeffler, Onkologie, Haematologie und Palliativmedizin, Leipzig; Ursula Kronawitter, Onkologische Schwerpunktpraxis, Traunstein; Georg Bolz, Medizinische Klinik I, Ludwigshafen; Jochem Potenberg, Waldkrankenhaus
| | - Georg Bolz
- Ralf-Dieter Hofheinz and Deniz Gencer, University Hospital Mannheim, Mannheim; Holger Schulz, Praxis Internistische Onkologie und Hämatologie, Frechen; Michael Stahl, Kliniken Essen-Mitte, Essen; Susanna Hegewisch-Becker, Hämatologisch-Onkologische Praxis Eppendorf, Hamburg; Luisa Mantovani Loeffler, Onkologie, Haematologie und Palliativmedizin, Leipzig; Ursula Kronawitter, Onkologische Schwerpunktpraxis, Traunstein; Georg Bolz, Medizinische Klinik I, Ludwigshafen; Jochem Potenberg, Waldkrankenhaus
| | - Jochem Potenberg
- Ralf-Dieter Hofheinz and Deniz Gencer, University Hospital Mannheim, Mannheim; Holger Schulz, Praxis Internistische Onkologie und Hämatologie, Frechen; Michael Stahl, Kliniken Essen-Mitte, Essen; Susanna Hegewisch-Becker, Hämatologisch-Onkologische Praxis Eppendorf, Hamburg; Luisa Mantovani Loeffler, Onkologie, Haematologie und Palliativmedizin, Leipzig; Ursula Kronawitter, Onkologische Schwerpunktpraxis, Traunstein; Georg Bolz, Medizinische Klinik I, Ludwigshafen; Jochem Potenberg, Waldkrankenhaus
| | - Felix Tauchert
- Ralf-Dieter Hofheinz and Deniz Gencer, University Hospital Mannheim, Mannheim; Holger Schulz, Praxis Internistische Onkologie und Hämatologie, Frechen; Michael Stahl, Kliniken Essen-Mitte, Essen; Susanna Hegewisch-Becker, Hämatologisch-Onkologische Praxis Eppendorf, Hamburg; Luisa Mantovani Loeffler, Onkologie, Haematologie und Palliativmedizin, Leipzig; Ursula Kronawitter, Onkologische Schwerpunktpraxis, Traunstein; Georg Bolz, Medizinische Klinik I, Ludwigshafen; Jochem Potenberg, Waldkrankenhaus
| | - Salah-Eddin Al-Batran
- Ralf-Dieter Hofheinz and Deniz Gencer, University Hospital Mannheim, Mannheim; Holger Schulz, Praxis Internistische Onkologie und Hämatologie, Frechen; Michael Stahl, Kliniken Essen-Mitte, Essen; Susanna Hegewisch-Becker, Hämatologisch-Onkologische Praxis Eppendorf, Hamburg; Luisa Mantovani Loeffler, Onkologie, Haematologie und Palliativmedizin, Leipzig; Ursula Kronawitter, Onkologische Schwerpunktpraxis, Traunstein; Georg Bolz, Medizinische Klinik I, Ludwigshafen; Jochem Potenberg, Waldkrankenhaus
| | - Andreas Schneeweiss
- Ralf-Dieter Hofheinz and Deniz Gencer, University Hospital Mannheim, Mannheim; Holger Schulz, Praxis Internistische Onkologie und Hämatologie, Frechen; Michael Stahl, Kliniken Essen-Mitte, Essen; Susanna Hegewisch-Becker, Hämatologisch-Onkologische Praxis Eppendorf, Hamburg; Luisa Mantovani Loeffler, Onkologie, Haematologie und Palliativmedizin, Leipzig; Ursula Kronawitter, Onkologische Schwerpunktpraxis, Traunstein; Georg Bolz, Medizinische Klinik I, Ludwigshafen; Jochem Potenberg, Waldkrankenhaus
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Zuo RC, Apolo AB, DiGiovanna JJ, Parnes HL, Keen CM, Nanda S, Dahut WL, Cowen EW. Cutaneous adverse effects associated with the tyrosine-kinase inhibitor cabozantinib. JAMA Dermatol 2015; 151:170-7. [PMID: 25427282 DOI: 10.1001/jamadermatol.2014.2734] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Cabozantinib S-malate is a vascular endothelial growth factor receptor 2, c-MET, and RET multitargeted tyrosine kinase inhibitor that has antiangiogenic and antitumorigenic properties with potential efficacy for the treatment of several cancers. Cutaneous reactions, one of the most frequently observed adverse effects associated with tyrosine kinase inhibitors, can significantly affect patients' quality of life and drug adherence and represent a major therapeutic challenge to maximizing the efficacy of targeted cancer therapy. OBJECTIVE To describe the frequency and spectrum of skin reactions in patients with urothelial carcinoma receiving cabozantinib as monotherapy. DESIGN, SETTING, AND PARTICIPANTS A single-institution study at the Clinical Research Center at the National Institutes of Health included 41 consecutive adults with metastatic, progressive urothelial carcinoma enrolled in a National Cancer Institute open-label, nonrandomized, phase 2 clinical trial. Patients receiving cabozantinib were evaluated for the development of skin reactions at each treatment visit from October 2012 to June 2014 by the primary oncology team and referred for dermatologic evaluation as appropriate. MAIN OUTCOMES AND MEASURES A detailed history, full-body physical examination, and clinical photographs of cutaneous lesions were obtained. RESULTS Of 41 consecutive patients who received cabozantinib, 30 (73%) developed 1 or more cutaneous toxic effects. Adverse events included hand-foot skin reaction (22 [54%]), generalized pigment dilution and/or hair depigmentation (18 [44%]), xerosis (8 [20%]), scrotal erythema/ulceration (6 [15%]), and nail splinter hemorrhages (5 [12%]). Eighteen patients (44%) had 2 or more cutaneous adverse events. Reactions developed in 17 of 30 patients (57%) during the first month of cabozantinib treatment and in 24 of 30 (80%) by the second month. Of patients with skin toxic effects, dose reduction was required for symptom management in 9 of 30 patients (30%), and treatment discontinuation was required in 4 of 30 (13%). CONCLUSIONS AND RELEVANCE Cabozantinib monotherapy is associated with 1 or more cutaneous adverse events in most patients. Early detection and prompt treatment may increase patients' adherence to tyrosine kinase inhibitor therapy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01688999.
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Affiliation(s)
- Rena C Zuo
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrea B Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - John J DiGiovanna
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Howard L Parnes
- Prostate and Urologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Corrine M Keen
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Swati Nanda
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - William L Dahut
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Edward W Cowen
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland4section editor, JAMA Dermatology
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