How We Do It

Management Of Tyrosine Kinase Inhibitor–Induced Hand–Foot Skin Reaction: Viewpoints from the Medical Oncologist, Dermatologist, and Oncology Nurse

Publish date: February 13, 2011

Table 4. Selected Skin Care Products for Use in HFSR

Adapted with permission from Anderson et al ⁴⁰

PRODUCTS	PRODUCT INFORMATION
Over-the-counter ^[40]^,^[45]^and ^[46]
Cetaphil^® (Galderma Laboratories, Ft. Worth, TX) skin cleaners, Aveeno^® (Johnson & Johnson, New Brunswick, NJ) shower gel	Nondeodorant, fragrance-free products
Udderly Smooth^® (Redex Industries, Salem, OH), Gold Bond^® (Chattem, Chattanooga, TN), Aveeno^®	Thicker products with more intense moisturizing properties than basic lotions; anti-itch formulations are available
Norwegian Formula: Smoothing Relief Anti-Itch Moisturizer (Neutrogena, Los Angeles, CA)	Contains dimethicone 1%, camphor 0.1%, and lidocaine
Norwegian Formula: Foot Cream (Neutrogena)	Contains cetearyl alcohol, dimethicone, menthol, and urea
Bag Balm^® (Dairy Association, Lyndonville, VT)	May provide “cooling” effect from eucalyptus
Eucerin^® (Beiersdorf, Hamburg, Germany) Cream	Best used at night due to greasy formulation
Eucerin^® Dry Skin Therapy	Contains urea and alpha-hydroxy acid
Aquaphor^® (Beiersdorf) Healing Ointment	Petrolatum 41%
Kerasal^® (Alterna, Whippany, NJ)	Salicylic acid 5% exfoliates and softens skin; urea 10% moisturizes skin
Blue Lizard^® (Crown Laboratories, Johnson City, TN)	UV A and B sunblock, water-resistant
Prescription^47–49
Urea 40% cream (Carmol 40^®; Doak Dermatologics, Fairfield, NJ)	Softens hyperkeratosis, decreases epidermal thickness, proliferation
Tazarotene 0.1% cream (Tazorac^®; Allergan Dermatology, Irvine, CA)	Retinoid decreases proliferation, reduces dermal inflammation
Fluorouracil 5% cream (Carac^®; Dermik Laboratories, Bridgewater, NJ)	Antifolate inhibits proliferation; has shown anecdotal benefit in certain conditions characterized by hyperkeratotic lesions on the palms and soles

Full-size table

Summary

The addition of molecularly targeted agents to anticancer treatment has been found to cause both common and novel adverse reactions. HFSR is being increasingly recognized as a potential dose-limiting toxicity associated with sorafenib or sunitinib treatment that can result in discomfort, pain, decreased quality of life, and premature termination of a potentially effective cancer treatment. It is important to educate patients about potential dermatologic adverse effects associated with TKIs because limiting toxicity can help avoid treatment interruptions or dose reductions while improving ADLs.

The precise pathogenic mechanism of HFSR is currently not known, and there is no evidence-based protocol for treatment of HFSR. However, the increased clinical experience with these agents has resulted in a wealth of published articles describing empiric and symptomatic approaches that appear to help to prevent and manage HFSR. Frequent communication is necessary between the physician and patient, particularly 2–4 weeks from the initiation of therapy. Symptoms of HFSR should be recognized as early as possible. Providing the patient with a brochure about HFSR to refer to at home may facilitate the early identification of HFSR.

Patients should be advised of the “3C” approach to the management of TKI-associated HFSR: control calluses, comfort with cushions, and cover with creams. Creams should be applied after bathing and before going to bed; cotton gloves and socks should be worn to keep the cream on the hands and feet during the night.

Symptoms of HFSR typically are manageable with the implementation of supportive measures. If symptoms worsen, dose modification or interruption will result in a return to grade 0/1. Many patients can successfully be rechallenged with the full dose. Observations across multiple viewpoints have consistently shown that HFSR severity can be reduced in patients who are educated about HFSR and proactive about its detection and management.

Acknowledgments

All authors contributed equally to the development of this report. Editorial support was provided by Katherine Wright, PharmD, RPh, ISD, Wrighter Medical Education and Training, West Hills, CA; John A. Ibelli, CMPP, BelMed Professional Resources, New Rochelle, NY; and John D. Zoidis, MD, Bayer HealthCare Pharmaceuticals, Montville, NJ.

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Management Of Tyrosine Kinase Inhibitor–Induced Hand–Foot Skin Reaction: Viewpoints from the Medical Oncologist, Dermatologist, and Oncology Nurse

Summary

Acknowledgments

References1

Pages

Recommended Reading

References ¹