Palmar plantar erythrodysesthesia medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mandana Chitsazan, M.D. [2]

Overview

Dose reduction, lengthening the interval between dose administration, and ultimately drug withdrawal are the most effective strategies. Specific treatments include cooling the extremities during drug administration, vitamin B6, topical and oral corticosteroids, and topical 99% dimethyl sulfoxide.

Medical Therapy

Treatment Attempted for PPE caused by
Cooling the extremities during drug administration[11] [12] [13] [14]
  • Liposome-encapsulated doxorubicin
  • Docetaxel
Pyridoxine (vitamin B6)[15] [16] [17] [18] [19] [20] [21] [22] [15] [23] [24] [4] [25]
  • Liposome-encapsulated doxorubicin
  • Fluorouracil
  • Doxorubicin
  • Docetaxel
  • Capecitabine
  • Etoposide
Potent topical corticosteroids[4] [26] [27] [17]

(The best results have been demonstrated when used in conjunction with cold compresses and emollients)

  • Liposomle-encapsulated doxorubicin
  • Fluorouracil
  • Cisplatin
  • Docetaxel
Oral corticosteroids
  • Liposome-encapsulated doxorubicin
  • Fluorouracil
  • Cytarabine
  • Doxorubicin
  • Bleomycin
  • Methotrexate
  • Vinorelbine
Topical 99% dimethyl sulfoxide
  • Liposome-encapsulated doxorubicin

References

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  2. Abushullaih S, Saad ED, Munsell M, Hoff PM (2002). "Incidence and severity of hand-foot syndrome in colorectal cancer patients treated with capecitabine: a single-institution experience". Cancer Invest. 20 (1): 3–10. PMID 11853000.
  3. Hansen RM, Quebbeman EJ, Ritch PS, Frick J, Anderson T (1987). "Continuous 5-fluorouracil infusion and pulse methotrexate/leucovorin for colorectal adenocarcinoma. A report of excessive toxicity". Am J Clin Oncol. 10 (3): 216–8. PMID 3496002.
  4. 4.0 4.1 4.2 Gordon KB, Tajuddin A, Guitart J, Kuzel TM, Eramo LR, VonRoenn J (1995). "Hand-foot syndrome associated with liposome-encapsulated doxorubicin therapy". Cancer. 75 (8): 2169–73. doi:10.1002/1097-0142(19950415)75:8<2169::aid-cncr2820750822>3.0.co;2-h. PMID 7697608.
  5. 5.0 5.1 Gerbrecht BM (2003). "Current Canadian experience with capecitabine: partnering with patients to optimize therapy". Cancer Nurs. 26 (2): 161–7. PMID 12660565.
  6. Nagore E, Insa A, Sanmartín O (2000). "Antineoplastic therapy-induced palmar plantar erythrodysesthesia ('hand-foot') syndrome. Incidence, recognition and management". Am J Clin Dermatol. 1 (4): 225–34. doi:10.2165/00128071-200001040-00004. PMID 11702367.
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  8. Cassidy J, Twelves C, Van Cutsem E, Hoff P, Bajetta E, Boyer M; et al. (2002). "First-line oral capecitabine therapy in metastatic colorectal cancer: a favorable safety profile compared with intravenous 5-fluorouracil/leucovorin". Ann Oncol. 13 (4): 566–75. doi:10.1093/annonc/mdf089. PMID 12056707.
  9. O'Shaughnessy J, Miles D, Vukelja S, Moiseyenko V, Ayoub JP, Cervantes G; et al. (2002). "Superior survival with capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with advanced breast cancer: phase III trial results". J Clin Oncol. 20 (12): 2812–23. doi:10.1200/JCO.2002.09.002. PMID 12065558.
  10. Lokich JJ, Ahlgren JD, Gullo JJ, Philips JA, Fryer JG (1989). "A prospective randomized comparison of continuous infusion fluorouracil with a conventional bolus schedule in metastatic colorectal carcinoma: a Mid-Atlantic Oncology Program Study". J Clin Oncol. 7 (4): 425–32. doi:10.1200/JCO.1989.7.4.425. PMID 2926468.
  11. Molpus KL, Anderson LB, Craig CL, Puleo JG (2004). "The effect of regional cooling on toxicity associated with intravenous infusion of pegylated liposomal doxorubicin in recurrent ovarian carcinoma". Gynecol Oncol. 93 (2): 513–6. doi:10.1016/j.ygyno.2004.02.019. PMID 15099971.
  12. Mangili G, Petrone M, Gentile C, De Marzi P, Viganò R, Rabaiotti E (2008). "Prevention strategies in palmar-plantar erythrodysesthesia onset: the role of regional cooling". Gynecol Oncol. 108 (2): 332–5. doi:10.1016/j.ygyno.2007.10.021. PMID 18083217.
  13. Zimmerman GC, Keeling JH, Burris HA, Cook G, Irvin R, Kuhn J; et al. (1995). "Acute cutaneous reactions to docetaxel, a new chemotherapeutic agent". Arch Dermatol. 131 (2): 202–6. PMID 7857119.
  14. Zimmerman GC, Keeling JH, Lowry M, Medina J, Von Hoff DD, Burris HA (1994). "Prevention of docetaxel-induced erythrodysesthesia with local hypothermia". J Natl Cancer Inst. 86 (7): 557–8. doi:10.1093/jnci/86.7.557. PMID 7907667.
  15. 15.0 15.1 Corrie PG, Bulusu R, Wilson CB, Armstrong G, Bond S, Hardy R; et al. (2012). "A randomised study evaluating the use of pyridoxine to avoid capecitabine dose modifications". Br J Cancer. 107 (4): 585–7. doi:10.1038/bjc.2012.318. PMC 3419962. PMID 22814578.
  16. Portal I, Cardenal F, Garcia-del-Muro X (1994). "Etoposide-related acral erythema". Cancer Chemother Pharmacol. 34 (2): 181. PMID 8194170.
  17. 17.0 17.1 Vukelja SJ, Lombardo FA, James WD, Weiss RB (1989). "Pyridoxine for the palmar-plantar erythrodysesthesia syndrome". Ann Intern Med. 111 (8): 688–9. doi:10.7326/0003-4819-111-8-688. PMID 2529807.
  18. Vukelja SJ, Baker WJ, Burris HA, Keeling JH, Von Hoff D (1993). "Pyridoxine therapy for palmar-plantar erythrodysesthesia associated with taxotere". J Natl Cancer Inst. 85 (17): 1432–3. doi:10.1093/jnci/85.17.1432. PMID 8102408.
  19. Hui YF, Giles FJ, Cortes JE (2002). "Chemotherapy-induced palmar-plantar erythrodysesthesia syndrome--recall following different chemotherapy agents". Invest New Drugs. 20 (1): 49–53. PMID 12003194.
  20. Fabian CJ, Molina R, Slavik M, Dahlberg S, Giri S, Stephens R (1990). "Pyridoxine therapy for palmar-plantar erythrodysesthesia associated with continuous 5-fluorouracil infusion". Invest New Drugs. 8 (1): 57–63. PMID 2345070.
  21. Banfield GK, Crate ID, Griffiths CL (1995). "Long-term sequelae of Palmar-Plantar erythrodysaesthesia syndrome secondary to 5-fluorouracil therapy". J R Soc Med. 88 (6): 356P–357P. PMC 1295248. PMID 7629773.
  22. Mortimer JE, Anderson I (1990). "Weekly fluorouracil and high-dose leucovorin: efficacy and treatment of cutaneous toxicity". Cancer Chemother Pharmacol. 26 (6): 449–52. PMID 2225317.
  23. Vail DM, Chun R, Thamm DH, Garrett LD, Cooley AJ, Obradovich JE (1998). "Efficacy of pyridoxine to ameliorate the cutaneous toxicity associated with doxorubicin containing pegylated (Stealth) liposomes: a randomized, double-blind clinical trial using a canine model". Clin Cancer Res. 4 (6): 1567–71. PMID 9626479.
  24. Hui YF, Cortes JE (2000). "Palmar-plantar erythrodysesthesia syndrome associated with liposomal daunorubicin". Pharmacotherapy. 20 (10): 1221–3. PMID 11034047.
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  26. Katoh M, Kadota M, Nishimura Y (2004). "A case of docetaxel-induced erythrodysesthesia". J Dermatol. 31 (5): 403–6. PMID 15187308.
  27. Vakalis D, Ioannides D, Lazaridou E, Mattheou-Vakali G, Teknetzis A (1998). "Acral erythema induced by chemotherapy with cisplatin". Br J Dermatol. 139 (4): 750–1. PMID 9892931.