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 Table of Contents  
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 137-138

Sorafenib-induced hand-foot syndrome

Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India

Date of Web Publication16-Jun-2017

Correspondence Address:
Chaturbhuj Agrawal
Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/amhs.amhs_7_17

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How to cite this article:
Agrawal C, Jain P, Saini R, Goyal P. Sorafenib-induced hand-foot syndrome. Arch Med Health Sci 2017;5:137-8

How to cite this URL:
Agrawal C, Jain P, Saini R, Goyal P. Sorafenib-induced hand-foot syndrome. Arch Med Health Sci [serial online] 2017 [cited 2023 Mar 31];5:137-8. Available from: https://www.amhsjournal.org/text.asp?2017/5/1/137/208207


Sorafenib is a multikinase inhibitor used in the treatment of advanced hepatocellular carcinoma and second-line treatment of primary renal cell carcinoma and is approved by the Food and Drug Administration for the same. It is a small molecule multikinase inhibitor (tyrosine kinase, Raf serine/threonine kinases) and also inhibits vascular endothelial growth factor, platelet-derived growth factor beta, and tumor progression. Various adverse effects of sorafenib are gastrointestinal (diarrhea, increased amylase, and lipase, nausea, constipation), dermatological (acne, flushing, rash/desquamation, hand-foot syndrome [HFS], alopecia, and pruritus), hyperthyroidism, hypertension, and hypoalbuminemia.[1] HFS or palmoplantar erythrodysesthesia is chemotherapy or targeted therapy-induced acral erythema characterized by reddening, swelling, numbness, and desquamation on palms and soles that occur after administration of chemotherapeutic agents. Various reports of sorafenib-induced HFS has been previously published in literature.[2] We herein present a similar case who developed severe HFS with sorafenib requiring discontinuation of the drug and further dose reduction during subsequent follow-up.

A 60-year-old female patient diagnosed as a case of advanced hepatocellular carcinoma with Child-Pugh A status was started on Sorafenib 400 mg OD. Initially, she has shown improvement with respect to her improving clinical condition and normalization of liver function tests; however, within 2 months of starting treatment, she noticed redness, swelling pain, and sensation of burning and tingling over bilateral palms with the appearance of cracked and flecking skin [Figure 1]. She was diagnosed as Sorafenib-induced HFS and started on Local topical steroid (clobetasol cream), moisturizing exfoliant cream (Urea – Hafoos) and analgesics (celecoxib) for pain relief. Sorafenib was withheld due to severe toxic manifestations, and in view of no other potential approved agents, it is restarted after 7 days on symptomatic improvement at a lesser dose of 200 mg OD. At present, patient is on regular follow-up and symptomatically better.
Figure 1: Patient's image showing desquamative lesions palmer (a) and dorsal surface of the hand (b)

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There are no conflicts of interest.

  References Top

Robert C, Mateus C, Spatz A, Wechsler J, Escudier B. Dermatologic symptoms associated with the multikinase inhibitor sorafenib. J Am Acad Dermatol 2009;60:299-305.  Back to cited text no. 1
Sil A, Das NK. Sorafenib-induced hand-foot syndrome in a patient of renal cell carcinoma. Indian J Pharmacol 2014;46:334-6.  Back to cited text no. 2
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