[Impact of cutaneous toxicities associated with targeted therapies on quality of life. Results of a longitudinal exploratory study]

Efficacy of compound traditional Chinese medicine oil in alleviating regorafenib-induced hand–foot skin reaction

Objective

Regofinib is a novel, oral, anticancer target which greatly improves survival of patients with colorectal cancer. However, it causes 47%–71% patients occur hand–foot skin reaction (HFSR), which affects the quality of life (QOL) or prognosis of patients. However targeted and effective methods are rare. The study attempted to test the efficacy of the compound traditional Chinese medicine (CTCM) oil in relieving HFSR and improving the QOL.

Methods

The present study was conducted in 85 patients with metastatic colorectal cancer presenting with HFSR from July 2019 to June 2020. These patients were divided into the control group (n = 42) and the intervention group (n = 43). The HFSR in the control group was managed using traditional methods, whereas that in the intervention group was treated with a CTCM oil comprising five selected herbs. This oil functions by regulating the vascular endothelial growth factor receptor, inflammatory factors, and immune status, and it was provided to the patients to apply externally twice a day. HFSR remission and QOL were evaluated in both groups after 2 weeks of intervention.

Results

The post-intervention HFSR remission rate was significantly higher in the intervention group than in the control group (65.1% vs. 16.7%) (P < 0.01). The overall QOL, physical function, social function, and emotional function of the patients in the intervention group were significantly improved (P < 0.05), whereas the pain symptoms were more significantly improved (P < 0.01).

Conclusions

The CTCM oil can effectively alleviate HFSR and improve the QOL of patients using regorafenib.

[Quality of life in home-based cancer patients: A comparative study of chemotherapy administration route]

INTRODUCTION

Home healthcare can be totally different depending on the route of treatment: intravenous anticancer drugs involve regular contact with the health caregiver while the oral route leaves the patient completely autonomous. This cross-sectional research has a comparative purpose between the representations of disease and treatments, the self-efficacy and the quality of life of patients treated with oral anticancer drugs and those treated by intravenous route.

METHODS

The sample include 130 patients with cancer. Seventy-two are treated with intravenous chemotherapy and 48 by oral route. The protocol includes a questionnaire of disease representations (IPQ-r), treatment representations (BMQ), self-efficacy (GSES 10) and quality of life (QLQ-C30).

RESULTS

The administration route of anticancer treatment impacts the illness representations with the normalization of cancer. The intravenous route, by its invasive and time-consuming nature, increases difficulties in fulfilling family and professional roles. Moreover, side effects are correlated with the perceived dangerousness of the treatment and self-efficacy. Age and the length of time since the diagnosis affect respectively the understanding of the disease and the cognitive dimension of quality of life.

DISCUSSION

More than a difference in form of treatment, the whole pathway of healthcare has to be taken into account since it involves different psychological consequences, in particular about therapeutic choices or in terms of patient support.

Cutaneous reactions to targeted therapies in children with CNS tumors: A cross-sectional study

BACKGROUND

MAPK (RAS-RAF-MEK-ERK-MAP) and mTOR inhibitors are novel treatments for pediatric central nervous system (CNS) tumors. The literature on common cutaneous adverse reactions to these therapies is sparse in the pediatric population. The aim of this study was to describe common cutaneous adverse reactions to BRAF, MEK, and mTOR inhibitors in children with CNS tumors.

METHODS

In this cross-sectional study, patients younger than 21 years of age receiving BRAF, MEK, and mTOR inhibitor monotherapy for a CNS tumor were enrolled over a one-year period. Full body skin examination, photographs of dermatologic findings, and initial treatment recommendations were included at the initial visit, and follow-up skin examinations were recommended every three months.

RESULTS

Twenty-two patients were enrolled in the study. Fifty percent (11/22) received trametinib, a MEK inhibitor, 27.3% (6/22) received dabrafenib, a BRAF inhibitor, and 22.7% (5/22) received everolimus, an mTOR inhibitor. Median age at visit was 11 years (range, 3-19). Median time from treatment initiation to skin examination was 4.5 months (range, 0-43). Ninety-six percent (21/22) of all patients had at least one skin reaction. The most common reactions across treatment groups included follicular/acneiform eruptions and xerosis. Two patients on MEK inhibitors and one patient on a BRAF inhibitor required therapy cessation due to severe cutaneous reactions.

CONCLUSIONS

Cutaneous reactions to targeted anticancer therapy in children are common, treatable, and rarely require drug dose reduction or discontinuation. Routine surveillance and early intervention may improve quality of life and facilitate continuation of life-saving therapy.

Psychosocial Impact of Personalized Therapies in Oncology

Personalized medicine is a keyword in modern oncology summarizing biomarker-driven targeted therapies. Those novel agents enhance our therapeutic portfolio and offer new options for our patients. But the term is often misleading and implicates a tailored therapy to the individual person, but it rather means a treatment stratified on genetic characteristics of the tumor. Molecular therapies raise expectations of curability or long-term treatments making former life-threatening diseases to more chronic ones but this is true only for some patients. So we have to carefully communicate with our patients about the options and limitations of those modern therapies not to trigger disappointments.

Living with the Effects of Cutaneous Toxicities Induced by Treatment

The introduction of targeted therapies in cancer treatment was accompanied with promising results including tumor control and patients survival benefits. However, these drugs just like their predecessors were associated with systemic side effects, including frequent and various cutaneous effects. Targeted therapies such as epidermal growth factor receptor, vascular endothelial growth factor receptor, kit, platelet-derived growth factor receptor, and BCR-ABL inhibitors as well as mammalian target of rapamycin inhibitors can induce cutaneous toxicities of varying severity. There are scarce studies on the actual impact of these toxicities on the patients' lives including the physical, social, and psychological aspects and overall quality of life. Patient's perspective in living with and beyond these toxicities remains largely uncharted but essential in optimizing care provided to those receiving treatment with targeted therapies.

Impact of Skin Toxicities Associated with Targeted Cancer Therapies on Body Image: A Prospective Study

BACKGROUND AND OBJECTIVE

Body-image issues associated with dermatological side effects induced by anticancer-targeted therapies have not been specifically explored until now despite growing literature about their impact on quality of life. Prospective and longitudinal investigations were needed. The aim of our study was to describe body-image changes occurring with cutaneous toxicities and their psychosocial impact on patients.

PATIENTS AND METHODS

Thirty-three patients were evaluated four times during the first 3 months of targeted therapy in terms of body satisfaction, physical attitudes and depression with validated and ad hoc questionnaires. The NCI-CTCAE V4.0 was used to grade adverse dermatological events. Descriptive and inferential analyses were conducted with SPSS 14.0 software.

RESULTS

Ninety-four per cent of the patients developed skin toxicities. Body satisfaction remained stable and slightly better than average over this period. About one-third of the patients reported body-image issues at baseline. Body satisfaction and depression levels at baseline appeared to be significantly associated with body-image issues after 3 months of therapy.

CONCLUSION

In the framework of regular dermatological monitoring, skin toxicities did not appear to be associated with body-image issues. Body satisfaction and depressive symptoms at the beginning of targeted therapy emerged as critical factors that practitioners should consider in order to prevent deterioration of body image that could impact on quality of life and compromise compliance.

Impact of dermatologic adverse events induced by targeted therapies on quality of life

BACKGROUND

Investigations about the impact of dermatologic adverse events on quality of life in the context of targeted therapies are quite recent and results vary in some dimensions. This article aims to summarize the existing data and to clarify needs in terms of clinical management and future research.

METHODS

A literature review was done with Pubmed, Medline, Scopus and PsycInfo databases and it combined the empirical studies published in English and in French over the past ten years.

RESULTS AND CONCLUSIONS

Dermatologic adverse events globally have a low to moderate impact on quality of life, mainly in the physical and emotional domains. Reasons for inter-individual variations in adjustment and long-term impact are still not well known. Making quality of life assessments systematic, making early referrals of patients to dermatology consultations and giving more attention to individual experience were identified as measures that could help prevent deterioration in quality of life.

Nail toxicities induced by systemic anticancer treatments

Patients treated with systemic anticancer drugs often show changes to their nails, which are usually well tolerated and disappear on cessation of treatment. However, some nail toxicities can cause pain and functional impairment and thus substantially affect a patient's quality of life, especially if they are given taxanes or EGFR inhibitors. These nail toxicities can affect both the nail plate and bed, and might present as melanonychia, leukonychia, onycholysis, onychomadesis, Beau's lines, or onychorrhexis, as frequently noted with conventional chemotherapies. Additionally, the periungual area (perionychium) of the nail might be affected by paronychia or pyogenic granuloma, especially in patients treated with drugs targeting EGFR or MEK. We review the nail changes induced by conventional chemotherapies and those associated with the use of targeted anticancer drugs and discuss preventive or curative options.

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

Regorafenib is an oral multikinase inhibitor licensed for use in gastrointestinal cancers. In clinical trials, regorafenib showed a consistent toxicity profile, including clinically significant hand–foot skin reaction (HFSR). Treatment modifications and symptomatic measures, as recommended in this review, can be used to manage HFSR and help patients to continue treatment at an optimal dose.

Background

Regorafenib is an orally available, small-molecule multikinase inhibitor with international marketing authorizations for use in colorectal cancer and gastrointestinal stromal tumors. In clinical trials, regorafenib showed a consistent and predictable adverse-event profile, with hand–foot skin reaction (HFSR) among the most clinically significant toxicities. This review summarizes the clinical characteristics of regorafenib-related HFSR and provides practical advice on HFSR management to enable health care professionals to recognize, pre-empt, and effectively manage the symptoms, thereby allowing patients to remain on active therapy for as long as possible.

Design

This review is based on a systematic literature search of the PubMed database (using synonyms of HFSR, regorafenib, and skin toxicities associated with targeted therapies or cytotoxic chemotherapy). However, as this search identified very few articles, the authors also use their clinical experience as oncologists and dermatologists managing patients with treatment-related HFSR to provide recommendations on recognition and management of HFSR in regorafenib-treated patients.

Results

Regorafenib-related HFSR is similar to that seen with other multikinase inhibitors (e.g. sorafenib, sunitinib, cabozantinib, axitinib, and pazopanib) but differs from the hand–foot syndrome seen with cytotoxic chemotherapies (e.g. fluoropyrimidines, anthracyclines, and taxanes). There have been no controlled trials of symptomatic management of regorafenib-related HFSR, and limited good-quality evidence from randomized clinical trials of effective interventions for HFSR associated with other targeted therapies. Recommendations on prevention and management of regorafenib-related HFSR in this review are therefore based on the expert opinion of the authors (dermatologists and oncologists with expertise in the management of treatment-related skin toxicities and oncologists involved in clinical trials of regorafenib) and tried-and-tested empirical experience with other multikinase inhibitors and cytotoxic chemotherapies.

Conclusions

As recommended in this review, treatment modifications and supportive measures to prevent, reduce, and manage HFSR can allow patients to continue regorafenib at the optimal dose to derive benefit from treatment.