Hand foot skin reaction in cancer patients treated with the multikinase inhibitors sorafenib and sunitinib
Hand foot skin reaction in cancer patients treated with the multikinase inhibitors sorafenib and sunitinib
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DOI：
10.1093/annonc/mdn389
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发表时间：
2008-11-01
影响因子：
50.5
通讯作者：
Guitart, J.
中科院分区：
文献类型：
--
作者：
Lacouture, M. E.;Reilly, L. M.;Guitart, J.
背景资料：本研究探讨了临床病理结果和管理的手足皮肤反应（HFSR）索拉非尼和舒尼替尼在皮肤科转诊中心癌症相关的毒性effects.Patients和方法：我们确定了12名患者谁开发HFSR在1年期间（2007年）。病历和组织学标本进行了调查的临床病理数据和结果management.Results：我们确定了12例HFSR索拉非尼（83%）或舒尼替尼（17%）治疗。大多数患者（75%）出现3级HFSR，中位Skindex评分为43。7例患者的活检显示角质细胞坏死的水平层，其与药物暴露时间相关：早期（从开始< 30天）导致颗粒层-棘层改变，晚期（>= 30天）导致角质层病理学。局部尿素单药治疗（n = 3），联合他扎罗汀治疗（n = 7），或氟尿嘧啶治疗（n = 2），大多数患者（58%）改善≥ 2级，5例患者（42%）改善1级（P = 0.007）。中位Skindex评分在后续为32（P = 0.22）。结论：有独特的临床病理特征HFSR由于多激酶抑制剂，与时间的代理开始。用具有角质层溶解、抗增殖和抗炎特性的局部药物治疗显示出益处。
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 (>= 30 days) resulting in stratum corneum pathology. Treatment with topical urea singly (n = 3), plus tazarotene (n = 7), or fluorouracil (n = 2) resulted in >= 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.