Hand-foot syndrome due to sorafenib in hepatocellular carcinoma treated with vitamin E without dose modification; a preliminary clinical study.

PURPOSE

Sorafenib has been found to have significant clinical activity against hepatocellular carcinoma (HCC). Hand-foot skin syndrome (HFS) has been described with the usage of sorafenib. It is a dose-limiting toxicity and may lead to compromised efficacy because of dose reduction.

METHODS

From 14 patients diagnosed with HCC 10 who developed HFS while on treatment with sorafenib were included in this study. Sorafenib was administered orally at a dose of 400 mg twice daily vitamin E usage can be effective in HFS due to sorafenib, therefore vitamin E 300 mg/day was started when HFS occurred. HFS was graded according to the National Cancer Institute (NCI) criteria.

RESULTS

Grade 2-3 HFS was found in 10 of 14 patients. Vitamin E was started to all patients without using topical agents. Mean time to the appearance of HFS was 15 ± 3 days (range 10-22) after starting sorafenib. Grade was 3 in 4 patients, 2 in 4 patients and 1 in 2 patients. Vitamin E administration had a marked effect after 10-12 days of its initiation. Skin lesions disappeared without any dose modification.

CONCLUSION

Sorafenib is the gold standard for HCC treatment. Dose modification due to HFS decreases the effectiveness of this agent. Adding vitamin E to sorafenib is effective in HFS without dose reduction or treatment interruption. This is the first clinical study to report resolution of HFS with vitamin E due to sorafenib therapy.