Sorafenib-associated hand-foot skin reaction: practical advice on diagnosis, mechanism, prevention, and management

ABSTRACT

Introduction: Sorafenib is a multitargeted tyrosine kinase inhibitor, which has been mainly used in the treatment of advanced hepatocellular carcinoma and renal cancer. However, hand-foot skin reaction (HFSR), as one of the most common adverse reactions, have hindered its long-term clinical application. At present, the mechanism of its occurrence has not been clearly studied and it leads to the lack of effective means of intervention. This article reviews known mechanism and management methods of HFSR caused by sorafenib.

Areas covered: The author reviews HFSR caused by the treatment of sorafenib including the mechanism and management. English language reports located through PubMed are reviewed.

Expert opinion: There are some conjectures about the mechanism of HFSR. However, the mechanism of HFSR induced by sorafenib is still unclear at present. In the absence of understanding the mechanism of HFSR, the most common method for clinical treatment of sorafenib-induced HFSR is dose down-regulation or discontinuation of treatment, which affects efficacy and even survival. Future research should focus on the mechanism of HFSR to find out new ways for prevention. Precautionary measures before the occurrence of HFSR can also be studied in the future.

KEYWORDS:

• Hand-foot skin reaction
• management
• signaling pathway
• sorafenib
• toxic reaction

Article highlights

• HFSR often occurs when patients are treated with sorafenib, and patients need to decrease the dose of sorafenib or stop using it if the symptom is very serious.

• Although the occurrence rate of HFSR is very high, the mechanism of HFSR induced by sorafenib is still unclear at present.

• Managements of HFSR caused by sorafenib include taking some preventative measures or dose adjustment.

• The biomarkers of HFSR are expected to achieve individualized and precise medical treatment for patients, so as to achieve better efficacy.

• At present, the mechanism of HFSR need to be further gone into.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

A reviewer on this manuscript has disclosed that they are a consultant for Bayer AG. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This work was supported by National Natural Science Foundation of China (Nos. 81773816 and 81872941) and Science Technology Plan Project of Zhejiang Province (No. 2019C04010).