Capecitabine-induced oral mucosal hyperpigmentation associated with hand-foot syndrome - A literature review

Abstract Background Capecitabine (Xeloda®) is a cytotoxic, antimetabolite chemotherapeutic agent. Its most common adverse events are diarrhea, hand-foot syndrome (HFS), hyperbilirubinemia, hyperpigmentation, fatigue, abdominal pain, and other gastrointestinal effects. HFS or palmar-plantar erythrodysesthesia (PPE) is an adverse reaction resulting from therapy with chemotherapeutic agents, classified into three degrees. Hyperpigmentation, as an adverse effect of capecitabine, can occur in different locations and with different patterns. The skin, nails and oral mucosal membrane can be affected. Objective The objective of this study was to report and discuss oral hyperpigmentation associated with HFS caused by the use of capecitabine, which is still poorly described in the literature. Methodology A literature review was carried out using the online databases PubMed, Scielo, BVS, Lilacs, Medline, BBO and Google Scholar, associating the descriptors "Capecitabine", "Pigmentation Disorders", "Oral mucosa", "Cancer" and "Hand-Foot Syndrome", which were related and used to exemplify, discuss and report the exposed clinical case. Results This case report corroborates the literature regarding the incidence in females and black skin persons like this patient who was affected by HFS when undergoing antineoplastic therapy with capecitabine and presented hyperpigmentation of the hands, feet and oral mucosa. On the oral mucosa, the hyperpigmented spots were diffuse, showing a blackish color and irregular edges. Their pathophysiology remains unknown. Study limitations Few articles citing capecitabine-associated pigmentation. Conclusions It is hoped that this study may contribute to the identification and correct diagnosis of hyperpigmentation in the oral cavity, as well as call attention to the adverse effects related to capecitabine.

Analysis of association between severity of capecitabine-induced hand-foot syndrome and inflammatory factors / 药学实践杂志

Objective To investigate the correlation between plasma inflammatory factors [IL-1β, IL-6, IL-10, IL-12, IL-17, IL-23, TNF-α, TGF-β, IFN-γ, C-reactive protein (CPR) CCL-5] and hand-foot syndrome in colorectal cancer patients after taking capecitabine. Methods 35 colorectal cancer patients treated with capecitabine were collected and the degree of severity was divided according to the hand-foot syndrome grading diagnostic criteria. The concentrations of inflammatory factors in plasma were determined by ELISA kits. Results The standard curve of all inflammatory cytokines were linear (r>0.9900), and plasma concentrations of inflammatory cytokines in patients with colorectal cancer were determined. The concentration of TNF-α changed obviously, which had reference value. Conclusion The concentrations of different inflammatory factors were different and the concentration of TNF-α was closely correlated with the severity of hand-foot syndrome.

Topical interventions for preventing hand-foot syndrome resulting from antineoplastic therapy: A scoping review / Intervenciones tópicas para prevenir el síndrome mano-pie resultante de la terapia antineoplásica: revisión del alcance / Intervenções tópicas para prevenção de síndrome mão-pé decorrente de terapia antineoplásica: revisão de escopo

ABSTRACT Objective: To map topical interventions used to prevent hand-foot syndrome in cancer patients undergoing antineoplastic therapy. Method: This is a scoping review reported in accordance with the recommendations of PRISMA-ScR (extension for scoping review) and the Joanna Briggs Institute Manual. The searches were carried out in the electronic databases CINAHL, Cochrane CENTRAL, EMBASE, LILACS, LIVIVO, PubMed, Scopus, Web of Science; and gray literature (Google Scholar, Pro-Quest). Results: The searches resulted in 12,016 references and the final sample consisted of 45 studies. A total of 42 topical interventions were identified, including: moisturizing creams, corticosteroids, acids, mapisal, silymarin, and henna. However, urea was the most cited intervention (62%). As for the presentations of the interventions, they varied among creams, ointments, gels, hydrocolloids, decoctions, patches, powders, oils, and soaps. Conclusion: The results allowed reviewing topical interventions, with emphasis on the use of urea and moisturizing creams. However, most of the interventions identified in this review require evaluation in future studies for better understanding of their benefits.

RESUMEN Objetivo: Mapear las intervenciones tópicas utilizadas para prevenir el síndrome mano-pie en pacientes con cáncer sometidos a terapia antineoplásica. Método: Esta es una revisión del alcance reportada de acuerdo con las recomendaciones de PRISMA-ScR (extensión para la revisión del alcance) y el Manual del Instituto Joanna Briggs. Las búsquedas se realizaron en las bases de datos electrónicas CINAHL, Cochrane CENTRAL, EMBASE, LILACS, LIVIVO, PubMed, Scopus, Web of Science; y literatura gris (Google Scholar, Pro-Quest). Resultados: Las búsquedas resultaron en 12.016 referencias y la muestra final estuvo compuesta por 45 estudios. Se identificaron 42 intervenciones tópicas, entre ellas: cremas humectantes, corticoides, ácidos, mapisal, silimarina y henna. Sin embargo, la urea fue la intervención más citada (62%). En cuanto a las presentaciones de las intervenciones, variaron entre cremas, ungüentos, geles, hidrocoloides, decocciones, parches, polvos, aceites y jabones. Conclusión: Los resultados permitieron revisar las intervenciones tópicas, con énfasis en el uso de urea y cremas humectantes. Sin embargo, la mayoría de las intervenciones identificadas en esta revisión deben evaluarse en estudios futuros para mejor comprensión de sus beneficios.

RESUMO Objetivo: Mapear as intervenções tópicas utilizadas para a prevenção da síndrome mão-pé em pacientes com câncer em terapia antineoplásica. Método: Trata-se de uma revisão de escopo reportada de acordo com as recomendações do PRISMA-ScR (extensão para revisão de escopo) e o Manual do Instituto Joanna Briggs. As buscas foram realizadas nas bases eletrônicas CINAHL, Cochrane CENTRAL, EMBASE, LILACS, LIVIVO, PubMed, Scopus, Web of Science; e literatura cinzenta (Google Scholar, Pro-Quest). Resultados: As buscas resultaram em 12.016 referências e a amostra final foi composta por 45 estudos. Um total de 42 intervenções tópicas foram identificadas, dentre elas: cremes hidratantes, corticosteroides, ácidos, mapisal, silimarina e henna. Entretanto, a ureia foi a intervenção mais citada (62%). Quanto às apresentações das intervenções, estas variaram entre cremes, pomadas, géis, hidrocoloides, decocções, adesivos, pós, óleos e sabões. Conclusão: Os resultados possibilitaram uma recensão das intervenções tópicas, com destaque ao uso da ureia e cremes hidratantes. Todavia, grande parte das intervenções identificadas nesta revisão necessitam ser avaliadas, em estudos futuros, para melhor compreensão dos seus benefícios.

Oral hyperpigmentation as an initial clinical aspect of hand foot syndrome

Abstract Hand-foot syndrome (HFS) is a common adverse effect of anticancer therapy. It is known to cause dermatological symptoms including acral erythema and dysesthesia of the palms and soles of the feet, swelling, pain, itching, and scaling. Some drugs, like capecitabine, are known to trigger this condition. However, pigmentation of the oral mucosa is a rare adverse effect. This study aims to report a case of oral mucosa hyperpigmentation caused by capecitabine therapy before the clinical diagnosis of HFS. A 58-year-old female, diagnosed with invasive breast duct carcinoma, had the central nervous system, liver, skin, and lung metastasis, using capecitabine every day for 14 cycles. Oral examination revealed multifocal black macules on the hard palate, bilateral buccal mucosa, gingival mucosa, and dorsum of the tongue. The clinical hypothesis was oral mucosa hyperpigmentation by capecitabine use and only periodic follow-up was necessary. Hyperpigmentation of oral mucosa by capecitabine is a rare consequence of neoplastic therapy and your association with HFS is unclear, and poorly reported. The report of these events is important to alert oncology health teams about the individual tolerance to capecitabine therapy.

Resumo A síndrome mão-pé (SMP) é um efeito adverso comum da terapia anticâncer. Sabe-se que causa sintomas dermatológicos, incluindo eritema acral e disestesia das palmas das mãos e solas dos pés, inchaço, dor, coceira e descamação. Alguns medicamentos como a capecitabina são conhecidos por desencadear essa condição. No entanto, a pigmentação da mucosa oral é um efeito adverso raro. Este trabalho tem como objetivo relatar um caso de hiperpigmentação da mucosa oral causada pela terapia com capecitabina antes do diagnóstico clínico de SMP. Mulher de 58 anos, com diagnóstico de carcinoma invasivo de ducto mamário, apresentou metástase no sistema nervoso central, fígado, pele e pulmão, em uso de capecitabina todos os dias por 14 ciclos. O exame oral revelou máculas negras multifocais no palato duro, mucosa bucal bilateral, mucosa gengival e dorso de língua. A hipótese clínica foi de hiperpigmentação da mucosa oral pelo uso de capecitabina e apenas o acompanhamento periódico foi necessário. A hiperpigmentação da mucosa oral pela capecitabina é uma consequência rara da terapia neoplásica e sua associação com SMP não é clara e pouco relatada. O relato desses eventos é importante para alertar as equipes de saúde oncológica sobre a tolerância individual à terapia com capecitabina.

Intertrigo-like hand-foot syndrome unaffecting the site of surgery for axillary osmidrosis: the first case reported worldwide / 中华皮肤科杂志

A 25-year-old female patient presented with recurrent painful erythema and blisters on the palms and soles as well as in the axillary and inguinal regions for 1 month. Seven years ago, the patient underwent a small-incision sweat gland resection in the bilateral axillae for the treatment of axillary osmidrosis. One month ago, she underwent chemotherapy with pegylated liposomal doxorubicin (PLD) after surgery for stage-ⅡB cervical synovial sarcoma. During the 3 sessions of chemotherapy, she developed painful edematous erythema on the palms, soles, axillae and groins, which gradually worsened along with the increase in the number of chemotherapy sessions. Skin examination showed large areas of edematous erythema with clear boundaries at bilateral palms, soles, and intertriginous sites including axillae and groins, with millet- to soybean-sized blisters and erosions on the surface; the skin lesions showed relatively high temperature and positive Nikolsky's sign with obvious tenderness; there was no skin lesions or tenderness at the site of small-incision surgery for axillary osmidrosis in bilateral axillae. Histopathological examination of the axillary skin lesions showed formation of blisters under the basal layer and necrosis of some sweat glands. The diagnosis of PLD-associated intertrigo-like hand-foot syndrome was confirmed. The history of surgery for axillary osmidrosis and normal skin at the surgical site in this case suggest that the pathogenesis of this disease may be related to toxic skin reactions to the drug excreted through sweat glands.

Paraneoplastic Bullous Pemphigoid Masquerading as Hand-foot Syndrome: A Case Report of Rare Entity

@#Bullous pemphigoid (BP) is a chronic and the most frequent immune-mediated subepidermal blistering disorder which mainly affects elderly individuals. The autoantibodies produced following T-cell dysregulation are directed against BP180 (BPAg2) and BP230 (BPAg1), hemidesmosomal proteins located in the basement membrane zone (BMZ) of the epidermis. BP may present with polymorphic dermatological features including non-bullous manifestations and blisters. Therefore, a wide range of differential diagnoses such as eczema, urticaria, pemphigus and the differentials for subepidermal blister with eosinophils such as epidermolysis bullosa acquisita (EBA) and bullous drug eruptions should be considered in such cases. The associations of solid organ internal malignancies and BP are quite rare and vary between studies. Here, we present a case of paraneoplastic bullous pemphigoid (PNBP) in a patient with underlying renal cell carcinoma who was initially diagnosed with worsening hand-foot syndrome (HFS) which has led to withdrawal of his oral chemotherapy treatment.

Chinese expert consensus on management of adverse events of pegylated liposomal doxorubicin (2020 edition) / 中华肿瘤杂志

As a new type of anthracyclines, pegylated liposomal doxorubicin (PLD) is widely used in the treatment of a variety of malignant tumors, including soft tissue sarcoma, ovarian cancer, breast cancer, multiple myeloma, and so on. Compared with traditional anthracyclines, PLD can significantly decrease the incidences of adverse events such as cardiac toxicity and alopecia. However, the use of PLD will be accompanied with toxic side effects such as hand-foot syndrome, oral mucositis, and infusion reaction. This consensus will mainly focus on the mechanism, prevention and treatment of adverse events of PLD, in order to improve the therapeutic efficacy of PLD and life quality of patients.

Curative effect of compound carraghenates cream combined with vitamin B6 in the treatment of hand-foot syndrome caused by capecitabine / 中国基层医药

Objective@#To observe the curative effect of compound carraghenates cream(Titanoreine) combined with vitamin B6 in the treatment of hand-foot syndrome caused by capecitabine(Xeloda).@*Methods@#From December 2015 to December 2017, 97 cases of middle and advanced colorectal cancer in the First People's Hospital of Yongkang were selected.All patients were treated by chemotherapy regimens of capecitabine as priority after operation, but later hand-foot syndrome appeared and they were randomly divided into treatment group (48 cases) and control group (49 cases) according to the digital table.In control group, only vitamin B6 30 mg was taken orally, three times daily; while in treatment group, vitamin B6(30 mg) combined with compound carraghenate cream (1g) were taken orally, three times daily after hand-foot syndrome occurred.The improvement, total efficiency, pain score during the treatment process (the first, fifth, ninth day after treatment), adverse reactions were observed before and after treatment in two groups.@*Results@#After treatment, the hand-foot syndrome in the treatment group and the control group was improved, the difference was statistically significant (treatment group: Z=6.477, P=0.000; control group: Z=4.700, P=0.000). The total effective rate of the treatment group was 87.5%(42/48), which was significantly higher than 65.3%(32/49) of the control group (χ2=6.603, P=0.010). The pain score on the ist day after treatment had no statistically significant differences between the two group[treatment group: (2.88±1.82)points, control group: (3.14±1.74)points, t=0.741, P=0.461] The pain scores on 5th and 9th day after treatment in the treatment group were (2.29±1.52)points, (1.23±1.80)points, respectively, which were lower than those in the control group [(2.94±1.38)points, (2.14±1.90)points](t=2.200, 2.430, P=0.030, 0.017). There were no statistically significant differences between the two groups in general conditions and the incidence of adverse reactions after drugs uses(all P<0.05).@*Conclusion@#Compound carraghenate cream combined with vitamin B6 has significant effect in the treatment of hand-foot syndrome caused by capecitabine, which can improve hand-foot syndrome better and help tumor patients to finish the chemotherapy successfully.

A case report on sorafenib induced adverse reaction

Sorafenib is an oral multi-kinase inhibitor used primarily in the treatment of hepatic cellular carcinoma, renal cell carcinoma, and thyroid carcinoma. Hand-foot syndrome also is known as palmar-plantar erythrodysesthesia causes reddening, numbness, swelling of palms of hands and soles of feet. In this report, a known case of renal cell carcinoma, post right nephrectomy patient on treatment with tab sorafenib had developed the hand-foot syndrome

Hand-foot syndrome due to hepatitis C therapy

SUMMARY INTRODUCTION Direct-acting antivirals are new drugs for chronic hepatitis C treatment. They are usually safe and well tolerated, but can sometimes cause serious adverse effects and there is no consensus on how to treat or prevent them. We described a case of hand-foot syndrome due to hepatitis C virus interferon-free therapy. METHODS We report the case of a 49-year-old man with compensated liver cirrhosis due to chronic hepatitis C genotype 1, treatment-naïve, who started viral treatment with sofosbuvir, simeprevir and ribavirin for 12 weeks. RESULTS At the sixth week of treatment he had anemia, requiring a lower dose of ribavirin. At the tenth week, he had erythematous, pruritic, scaly and flaky lesions on hands and feet, which showed a partial response to oral antihistamines and topical corticosteroids. It was not necessary to discontinue antiviral treatment, but in the first week after the end of treatment, there was worsening of injuries, including signs of secondary infection, that required hospitalization, antibiotics and oral corticosteroid, with progressive improvement. Biopsy of the lesions was consistent with pharmacodermia. The patient had sustained a virological response, despite the side effect. He had a history of pharmacodermia one year ago attributed to the use of topiramate, responsive to oral corticosteroid. CONCLUSION Interferon-free therapies can rarely lead to severe adverse reactions, such as skin lesions. Patients receiving ribavirin combinations and those who had a history of pharmacodermia or skin disease may be more susceptible. There is no consensus on how to prevent skin reactions in these patients.

RESUMO INTRODUÇÃO Antivirais de ação direta são as novas drogas utilizadas no tratamento da hepatite C crônica. São geralmente seguros, com boa tolerância, mas eventualmente podem causar efeitos adversos graves, e não há consenso sobre como tratá-los ou preveni-los. Descrevemos um caso de síndrome mão-pé secundária à terapia livre de interferon para hepatite C crônica. Materiais e métodos Relatamos o caso de um paciente de 49 anos com cirrose hepática compensada secundária à hepatite C crônica, genótipo 1, virgem de tratamento, que iniciou terapia com sofosbuvir, simeprevir e ribavirina por 12 semanas. Resultados Na sexta semana de tratamento, apresentou anemia, sendo necessária redução de dose da ribavirina. Na 20a semana, apresentou lesões eritematosas e descamativas, com prurido em mãos e pés, que teve resposta parcial ao uso de anti-histamínico oral e corticoide tópico. Não foi necessário descontinuar os antivirais, mas na primeira semana após o término do tratamento, houve piora das lesões, com sinais de infecção secundária, sendo necessárias hospitalização e terapia com antibiótico e corticoide oral, com melhora progressiva. Biópsias das lesões foram compatíveis com farmacodermia. O paciente teve resposta virológica sustentada, apesar dos efeitos adversos. Tinha história de farmacodermia há um ano, atribuída ao uso de topiramato, responsiva a corticoterapia oral. Conclusão Os tratamentos livres de interferon raramente causam eventos adversos graves, como lesões cutâneas. Pacientes em uso de ribavirina e com história de farmacodermia ou doença cutânea prévia podem ser mais susceptíveis. Não existe consenso sobre como prevenir reações cutâneas nesses pacientes.

The influence of genetic variation of cytidine deaminase on hand-foot syndrome among colorectal cancer patients treated with capecitabine-based adjuvant chemother-apy regimens / 中国肿瘤临床

Objective:To investigate the association between grade 3 hand-foot syndrome(HFS)in colorectal cancer(CRC)patients treated with capecitabine and variation of cytidine deaminase(CDA)genes.Methods:The polymorphisms of the key gene CDA in-volved in capecitabine metabolism were genotyped and 149 CRC patients were included in this study.The association between these polymorphisms and susceptibility to HFS were analyzed.Additionally,peripheral blood mononuclear cells(PBMCs)of 91 CRC patients were collected for mRNA expression analysis, and the levels of mRNA expression according to different CDA genotypes were com-pared.Results:The prevalence of the polymorphism-451G>A,which is located in the promoter region of CDA,were correlated with HFS. The results were as follows: GG genotype, 109 cases (73.15%); GA genotype, 38 cases (25.50%); and AA genotype, 2 cases (1.36%).The minor allele frequency of-451G>A was 0.14.The distribution of the three genotypes were in accordance with Hardy-Weinberg Equilibrium(P=0.516).Logistic analysis indicated that GA/AA genotypes were associated with grade 3 HFS(odds ratio=2.53, P=0.011).Additionally,another insert polymorphism-33delC located in the promoter region of CDA was in linkage disequilibrium with-451G>A (D'=0.92). Of the 91 PBMC mRNA expression analyses, the GA/AA genotype of-451G>A was associated with higher CDA mRNA expression compared with GG genotypes(4.01±0.53 vs.3.13±0.61,P<0.001).Conclusions:The polymorphism-451G>A of CDA may influence occurance of grade 3 HFS induced by capecitabine by influencing CDA mRNA expression.

Research progress of relationship between capecitabine related gene polymorphisms and hand-foot syndrome / 实用肿瘤学杂志

In recent years,capecitabine is widely used in clinical practice.Hand-foot syndrome is a dose-limiting toxicity, often manifested as numbness in the hands and feet,sensation of dullness,tingling,skin swelling or erythema,scaling,blisters or seri-ous pain.Its occurrence has seriously affected the chemotherapy effect and daily life of patients.Genetic mutations of capecitabine met-abolic enzymes play an important role in the drug efficacy and side-effect.In particular,the relationship between gene polymorphisms of CDA,CES,TP,DPD,TYMS,MTHFR and hand-foot syndrome has been widely investigated and achieved by researchers.This arti-cle reviews the relationship between capecitabine metabolizing enzymes and hand-foot syndrome in order to provide a reference for i-dentifying the biological target of hand-foot syndrome caused by capecitabine chemotherapy.

Síndrome mão-pé induzida por capecitabina: relato de caso / Capecitabine-induced hand-foot syndrome: a case repor / Síndrome mano-pie inducido por capecitabina: relato de caso

A capecitabina é um agente quimioterápico indicado, dentre outros casos, como monoterapia no câncer de mama metastático. A síndrome mão-pé consiste numa das reações adversas associadas ao seu uso e caracteriza-se por eritema doloroso, edema, disestesia, descamação, bolhas e úlceras nas regiões palmar e plantar. Objetivou-se descrever o caso de uma paciente portadora de carcinoma de mama esquerda com metástase hepática que apresentou síndrome mão-pé decorrente do tratamento com capecitabina. Trata-se de um relato de caso ocorrido num hospital universitário de um estado do nordeste do Brasil em 2016. Foi necessária a suspensão do protocolo antineoplásico utilizado. Observou-se remissão parcial dos sintomas após o uso do gel de Aloe vera para o tratamento das áreas afetadas. Ressalta-se a importância do relato para conhecimento dessa reação adversa, facilitando sua identificação e manejo, para promover melhora da qualidade de vida do paciente oncológico (AU).

Capecitabine is a chemotherapeutic agent indicated, among other things, as monotherapy for metastatic breast cancer. Hand-foot syndrome is one of the adverse effects associated with its use and is characterized by painful erythema, edema, dysesthesia, desquamation, blistering and ulcers in the palms and soles. This study presents a case report on a patient with left-sided breast cancer metastasized to the liver, who suffered from capecitabine-induced hand-foot syndrome. The patient was being treated at a university hospital in a state in the Northeast of Brazil in 2016. Her antineoplastic protocol had to be suspended. After the use of Aloe vera gel to treat the affected areas, there was a partial remission of symptoms.It is important to expand knowledge about this adverse reaction, facilitating its identification and management, in order to improve quality of life in cancer patients (AU).

La capecitabina es un agente quimioterápico indicado, entre otros casos, como monoterapia en cáncer de mama metastático. El síndrome mano-pie consiste en una de las reacciones adversas asociadas a su uso, caracterizada por eritema doloroso, edema, parestesia, descamación, ampollas y úlceras en regiones palmar y plantar. Se objetivó describir el caso de una paciente con carcinoma en mama izquierda, con metástasis hepática presentando síndrome de mano-pie derivado del tratamiento con capecitabina. Relato de caso ocurrido en hospital universitario de estado del Noreste brasileño en 2016. Fue necesaria la suspensión del protocolo antineoplásico utilizado. Se observó remisión parcial de los síntomas luego de uso de gel de Aloe Vera para tratamiento de las áreas afectadas. Se destaca la importancia del relato para conocimiento de esta reacción adversa, permitiendo su identificación y manejo, promoviendo mejora de calidad de vida del paciente oncológico (AU).

Do you know this syndrome? Hand-foot syndrome

ABSTRACT Hand-foot syndrome is a common cutaneous adverse effect associated with certain systemic chemotherapy drugs. It is characterized by erythema, edema, and burning sensation, especially over palmoplantar surfaces. We report the case of an elderly patient undergoing chemotherapy after a breast cancer surgery who developed symptoms two months after the start of the regimen. There are no studies that explore specific therapies. Suggestive therapy include reducing agent dosage, increasing the interval between cycles, or even stopping chemotherapy. Emollients, analgesics, and cold packs are described as effective. After alopecia and mucositis, hand-foot syndrome is the most common adverse dermatologic reaction to chemotherapeutic agents.

Clinical Observation of Wenjing Huayu Decoction for Chemotherapy-Induced Hand-Foot Syndrome / 浙江中医药大学学报

[Objective]To observe the curative effect of Wenjing Huayu Decoction for chemotherapy-induced hand-foot syndrome. [Methods]A total of 61 cases of patients with hand-foot syndrome induced by the oral administration of capecitabine were incorporated in the study, and further randomly divided into the treatment group(31 cases) and the control group(30cases). Capecitabine's dosage was 1250mg/m2,twice in one day,from the first day to the fourteen days,7 days of rest,with an observational period of 21 days.In the treatment group, patients were immersed with warm-water diluted Wenjing Huayu Decoction, from the first day of chemotherapy,once in the morning and once at night, 20 minutes a time, with an observational period of 21 days;besides, external application of urea cream was used for patients in the control group;patients in both groups applied corresponding treatment schemes twice a day, once in the morning and once at night, with an observational period of 21 days. The therapeutic effects in both groups were evaluated after 2 cycles of treatment. [Results]The effective rate of HFS was 67.7%in the treatment group and 36.7%in the control group. The results showed that the curative effect in the treatment group was significantly more efficient than that in the control group, with a statistical difference( P<0.05); according to the quality of life(QOL) scoring, there was an obvious difference in improving patients'quality of life between the two groups(P<0.05). [Conclusion]An immersion treatment applying Wenjing Huayu Decoction can be an effective regimen for the treatment of hand-foot syndrome induced by the administration of capecitabine, associated with improvement of patient's life quality.

Predictive role of hand-foot syndrome in patients receiving capecitabine plus bevacizumab for HER2-negative locally recurrent/metastatic breast cancer / 肿瘤

Objective: To observe the correlation between hand-foot syndrome (HFS) and prognosis of patients with human epidermal growth factor receptor 2 (HER2)- negative locally recurrent/metastatic breast cancer (LR/mBC) receiving chemotherapy with capecitabine (CAP) plus bevacizumab (BEV). Methods: One hundred patients with HER2-negative LR/mBC receiving first-line CAP plus BEV were divided into HFS group and non-HFS group, then the relationship between HFS and clinicopathologic characteristics of patients with HER2-negative LR/mBC and the related factors influencing the progression-free survival (PFS) and overall survival (OS) were analyzed by COX proportional hazards model. Results: There were statistically significant differences in menopausal status and the number of metastatic organs between HFS group and non-HFS group (all P < 0.05). The median PFS of the HFS group was significantly longer than that of the non-HFS group (10.7 months vs 5.8 months, P = 0.007). The median survival time of the HFS group was also significantly longer than that of the non-HFS group (22.8 months vs 14.9 months, P < 0.001). There was an association of Eastern Cooperative Oncology Group (ECOG) performance status (PS) score, hormone receptor status, metastasis at first diagnosis, metastatic organ site, the number of metastases and HFS with PFS (all P < 0.05). ECOG PS score, hormone receptor status, metastasis at first diagnosis, metastatic organ site and HFS were independent risk factors for PFS (all P < 0.05). There was an association of menopausal status, ECOG PS score, hormone receptor status, metastasis at first diagnosis, the number of metastatic organ and HFS with OS (all P < 0.05). Menopausal status, hormone receptor status, metastasis at first diagnosis, and HFS were independent risk factors for OS (all P < 0.05). Conclusion: HFS can be used as a predictor of therapeutic effect of HER2-negative LR/mBC patients receiving CAP-BEV. The patients with HFS have a better prognosis than patients without HFS.

The efficacy and safety of pegylated liposomal doxorubicin monotherapy and combination therapy with carboplatin in Korean patients with recurrent ovarian, fallopian tube, or primary peritoneal cancer: a single-institution experience

OBJECTIVE: This study aimed to evaluate the efficacy and safety of pegylated liposomal doxorubicin (PLD) with or without carboplatin in Korean patients with recurrent ovarian cancer (ROC), fallopian tube, or primary peritoneal cancer. METHODS: This retrospective study included 52 patients with ROC, fallopian tube, or primary peritoneal cancer who received PLD (50 mg/m²) between 1(st) December 2014 and 31(th) July 2016. RESULTS: The mean number of chemotherapy cycles was 3.8 (range, 2 to 9) in the PLD monotherapy group and 7 (range, 2 to 13) in the PLD combined with carboplatin (PLD-C) group. In overall response rates and clinical beneficial rates, PLD monotherapy group shows 5.0% and 17.5%, and PLD-C group shows 33.3% and 75.0%. The mean progression-free survival (PFS) was 5 and 13 months in the PLD monotherapy and PLD-C groups, respectively. At 6 months after treatment initiation, absence of disease progression was confirmed in 6 (15%) and 10 (83.3%) patients in the PLD monotherapy and PLD-C groups. Hematological adverse events (e.g., neutropenia and thrombocytopenia) were more common in the PLD-C group (P<0.001, P=0.004). The incidence of anemia and non-hematological adverse events, including mucositis, hand-foot syndrome, and allergic reactions, was similar in both groups. CONCLUSION: This study demonstrated the efficacy and safety of PLD monotherapy and PLD-C combination in Korean patients with ROC. This study would be helpful to consider the degree of worry about side effects and treatment expectations after treatment. Further retrospective studies with larger samples are required to confirm the efficacy of PLD monotherapy in Asian patients with platinum-resistant ROC.

Eritrodisestesia o síndrome mano pie. Presentación de dos casos y revisión de la literatura / Erythrodysesthesia or foot hand syndrome Presentation of two cases and review of the literature

La eritrodisestesia, o síndrome mano pie, es una reacción adversa relacionada con algunos agentes quimioterápicos. Se caracteriza por comenzar con un pródromo de disestesia palmo-plantar y, entre 2 a 4 días, la sensación progresa a un dolor quemante con edema y eritema en placas bien delimitadas y simétricas. Los quimioterápicos que se asocian con más frecuencia son la doxorrubicina, 5-fluorouracilo, capecitabina, citarabina y docetaxel. Es más frecuente y severo en mujeres, pacientes de edad avanzada o con compromiso vascular periférico. Se presentan dos pacientes de sexo femenino. La primera con cáncer de ovario en tratamiento con doxorrubicina liposomal que presentó eritrodisestesia luego del quinto ciclo de quimioterapia. La segunda paciente con diagnóstico de cáncer de mama que recibió tratamiento con capecitabina presentando síntomas luego del segundo ciclo de quimioterapia. El interés de la presentación es la consulta a dermatología por un síndrome que constituye un efecto adverso que potencialmente limita el uso de determinados antineoplásicos. Sin embargo, educando al paciente, con intervenciones farmacológicas y ajuste de dosis, es posible aliviar los síntomas continuando una terapéutica efectiva (AU)

Erythrodysesthesia, or hand foot syndrome, is a side effect related to some chemotherapeutic agents. It is characterized by a prodrome of palmoplantar dysesthesia followed by burning pain with edema and erythema on well-defined and symmetrical plaques, 2-4 days later. Doxorubicin, 5-fluorouracil, capecitabine, cytarabine and docetaxel are the most frequently associated chemotherapy drugs. Women, elderly or peripheral vascular compromise patients are more frequent and severe affected. Two female patients are reported. The first patient with ovarian cancer in treatement with liposomal doxorrubicin developed erythrodysesthesia after the fifth cycle of chemotherapy. Meanwhile the second patient diagnosed with breast cancer in treatment with capecitabine developed it after the second cycle of chemotherapy. The interest of this report is the dermatological consultation about a side effect syndrome which potentially limits the prescription of certain antineoplastic drugs. However, patients can continue specific treatment by indicating dose adjustment and prescribing medicine to relieve the symptoms (AU)

Chinese Herbal Medicine and Liquid Wax for the Treatment of 30 Patients with Apatinib-induced Hand-foot Syndrome / 上海针灸杂志

Objective To investigate the clinical efficacy of Chinese herbal medicine and liquid wax in treating oral apatinib-induced hand-foot syndrome. Method Thirty patients with gastric or gastroesophageal junction adenocarcinoma, who had developed hand-foot syndrome after oral administration of apatinib for four weeks, with grade 0 in 3 cases, grade Ⅰ in 16 cases, grade Ⅱ in 9 cases and grade Ⅲ in 2 cases, were enrolled and treated by external application of Chinese herbal medicine and liquid wax on both hands and feet for three weeks. Result The 30 patients with hand-foot syndrome had grade 0 in 14 cases, grade Ⅰ in 14 cases, grade Ⅱ in 2 cases and grade Ⅲ in 0 case after treatment with Chinese herbal medicine and liquid wax. There was a definite therapeutic effect and a statistically significant difference (P<0.05). Conclusion External application of Chinese herbal medicine and liquid wax on both hands and feet for hand-foot syndrome not only has a definite therapeutic effect but is also an ideal means of prevention and treatment because of its noninvasive procedure and the high compliance of the patients.

Development and Validation of the Korean Version of Hand-Foot Skin Reaction and Quality of Life Questionnaire (HF-QoL-K)

Given the growing number of cancer patients and the resulting increase in the administration of chemotherapeutic agents, convenient and effective methods for measuring the symptoms and quality of life associated with the hand-foot syndrome (HFS) are needed. Therefore, the aim of this study was to develop and validate the Korean version of the hand-foot skin reaction and quality of life questionnaire (HF-QoL-K), comprising a 20-item symptom domain and an 18-item daily activity domain. After we developed the HF-QoL-K, 209 Korean patients with gynecologic cancer who were undergoing chemotherapeutic agents relating the HFS were asked to fill in the questionnaire. The content validity, internal consistency reliability, and test-retest reliability were evaluated. The internal validity index, Cronbach’s alpha coefficient, and intra-class correlation coefficient of the HF-QoL-K were 0.90, 0.958, and 0.825 (95% confidence interval [CI], 0.774–0.865), respectively. The scatter plot (Pearson correlation coefficient, 0.826) and the Bland-Altman plot for test-retest reliability were also acceptable. The HF-QoL-K instrument is a valid and reliable questionnaire for the measurement of the symptoms and quality of life in Korean cancer patients suffering HFS.