Managing Angiogenesis Inhibitor Related Skin Toxicity

Mario E. Lacouture, MD, a dermatologist at Memorial Sloan-Kettering Cancer Center, describes the management of dermatologic adverse events that occur as a result of treatment with VEGFR and PDGFR inhibitors, such as sorafenib, sunitinib, axitinib, pazopanib, and regorafenib.

The antiangiogenesis agents lead to hand-foot skin reaction, which is a painful condition that can affect the palms and soles in 10% to 60% of patients, depending on the agent. This painful side effect usually occurs within the first two to four weeks of therapy. The incidence of hand-foot syndrome is much lower with axitinib and pazopanib. Patients should be advised of this side effect, before treatment.

Treatments for hand-foot skin reaction include topical agents, such as exfoliants, like 10% urea creams. These treatments have been shown to decrease the incidence of hand-foot skin reaction to sorafenib by 25%, in a study of over 800 patients, Lacouture notes.

Topical agents, such as those containing 6% salicylic acid or high potency corticosteroids, require a prescription. It is acceptable, Lacouture states, to use high potency topical corticosteroids in the palms and soles for several weeks to months at a time, since the skin in these areas is not as susceptible to the atrophying affects of topical corticosteroids. Additionally, Lacouture states, lidocaine-containing patches or lidocaine-containing creams are effective at treating very painful areas in the palms and soles.

Other adverse events occur as a result of treatment with angiogenesis inhibitors, notes Lacouture. These conditions vary depending on the treatment utilized, but can include alopecia, changes in skin color, splinter hemorrhages under the nails. Additionally, 40% of patients may develop maculopapular or erythematous rash on the face and chest. For these rashes, the use of topical steroid is likely to provide benefit and oral antibiotics are not needed, Lacouture suggests.