The Effect of Hand-Foot Skin Reaction Associated With the Multikinase Inhibitors Sorafenib and Sunitinib on Health-Related Quality of Life

November 2012 | Volume 11 | Issue 11 | Original Article | 61 | Copyright © November 2012

Introduction: The multikinase inhibitors sorafenib (SO) and sunitinib (SU) have shown benefit in a wide range of solid tumors. Although these agents are generally well tolerated, they may be associated with dermatologic adverse events, particularly hand-foot skin reaction (HFSR). The aim of this study is to evaluate the impact of HFSR associated with these multikinase inhibitors on patient health-related quality of life (HRQOL).
Methods: Twenty-three patients with HFSR related to SO or SU were graded using the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0 for clinical severity and for impact on HRQOL through completion of the patient self-administered Skindex-16 (SK-16). Clinical severity scores were compared to HRQOL assessments.
Results: Of the 23 patients with HFSR, clinical severity was grade 1 in 17.4%, grade 2 in 74%, and grade 3 in 8.6%. Median SK-16 scores were reported for symptoms (53.3), emotions (30.6), and functioning subscales (33.3). Median symptoms and emotions scores positively correlated with HFSR clinical severity grade.
Conclusions: These findings demonstrate that HFSR related to SO or SU negatively impacts HRQOL, with the symptoms domain being most significantly affected. In addition, CTCAE toxicity grading correlates with HRQOL.

J Drugs Dermatol. 2012;11(11)e61-e65.


Sorafenib (SO) and sunitinib (SU) are small molecule inhibitors with various targets that have shown benefits in various malignancies, significantly improving progression- free survival and overall survival, with reduced adverse events (AEs) when compared with cytotoxic chemotherapy.1
Sunitinib malate is an oral multitargeted tyrosine kinase inhibitor with antiangiogenic and antitumor activities. It is currently approved for the treatment of advanced renal cell carcinoma (RCC) and imatinib-resistant or imatinib-intolerant gastrointestinal stromal tumor (GIST).2 Sorafenib tosylate is also an orally active multikinase inhibitor (MKI) currently approved for the treatment of advanced RCC3 and hepatocellular carcinoma (HCC).4
Although targeted agents such as SO and SU are generally well tolerated, they cause a variety of AEs that should be promptly recognized for adequate clinical management.5 Cutaneous AEs associated with SO and/or SU are noteworthy for their relatively high frequency of occurrence: mucositis (up to 20% of patients), rash (up to 40%), alopecia (up to 27%), xerosis (up to 16%), xerostomia (up to 11%), and HFSR (up to 60%)6-9 (Figure 1).
One of the most clinically significant dermatologic AEs is HFSR, a localized cutaneous reaction characterized by erythema, edema, desquamation, pain, ulceration, or blistering, and affecting the bilateral palms and/or soles, symptoms that usually present several weeks after initiation of therapy.10 Although HFSR is not typically considered to be life-threatening, it occurs in up to 60% (up to 9% grade 3) of patients and can be painful, limiting daily activities. Depending on clinical severity, HFSR requires interventions that may include dose modification or discontinuation of treatment.9,11
Health-related quality of life (HRQOL) represents an important outcome measure in clinical research and practice that is commonly used to evaluate how illness can interfere with a person's day-to-day life.12 Such a measure describes levels of physical, social, and psychological well-being and assesses the burden of disease on daily living. These instruments are widely used in clinical trials to show how treatments for skin disease may