Abstract
Sorafenib is a novel, orally active, small molecule multikinase inhibitor, blocking both tumor cell proliferation and angiogenesis. Many patients experience skin reactions, including hand-foot skin reaction (HFSR), after receiving this agent. Here, we report eight patients with renal cell cancer treated with sorafenib in our hospital from April to November 2008. Seven were male, and the median age was 65 years (range 53–75 years). Seven patients (87.5％) experienced HFSR characterized by well-demarcated, erythematous plaques with blisters or hyperkeratosis on palmoplantar surfaces of pressure or flexure areas. They felt tingling sensation or pain in the affected skin. Skin biopsies of the lesions revealed necrotic keratinocytes, capillary dilation, and a mild perivascular lymphocytic infiltrate, all nonspecific findings. Dose reduction of sorafenib and treatment with topical corticosteroid and oral pyridoxine prevented symptoms from worsening. The pathogenesis of HFSR is still unknown, but an increase in drug concentrations in the capillary vessels and a direct cytotoxic effect of sorafenib on eccrine glands are the most likely and accepted hypotheses. Because the frequency of prescription for sorafenib is recently increasing, it is important to know about its adverse cutaneous effects, because they can sometimes lead to treatment discontinuation.
