Evolving strategies for the management of hand-foot skin reaction associated with the multitargeted kinase inhibitors sorafenib and sunitinib

Oncologist. 2008 Sep;13(9):1001-11. doi: 10.1634/theoncologist.2008-0131. Epub 2008 Sep 8.


The multitargeted kinase inhibitors (MKIs) sorafenib and sunitinib have shown benefit in patients with renal cell carcinoma, hepatocellular carcinoma (sorafenib), and gastrointestinal stromal tumor (sunitinib). Their efficacy in other malignancies is currently being investigated because of their broad range of activity. The effectiveness of these drugs is somewhat diminished by the development of a variety of toxicities, most notably hand-foot skin reaction (HFSR). Although HFSR does not appear to directly affect survival, it can impact quality of life and lead to MKI dose modification or interruption, potentially limiting the antitumor effect. Currently, no standard guidelines exist for the prevention and management of MKI-associated HFSR. To address this issue, an international, interdisciplinary panel of experts gathered in January 2008 to discuss and evaluate the best-practice management of these reactions. Based on these proceedings, recommendations for the management of HFSR have been provided to offer patients the best possible quality of life while taking these drugs and to optimize the patient benefit associated with MKI therapy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Benzenesulfonates / adverse effects*
  • Benzenesulfonates / pharmacology
  • Foot Dermatoses / chemically induced*
  • Foot Dermatoses / therapy*
  • Hand Dermatoses / chemically induced*
  • Hand Dermatoses / therapy*
  • Humans
  • Indoles / adverse effects*
  • Indoles / therapeutic use
  • Neoplasms / drug therapy
  • Niacinamide / analogs & derivatives
  • Phenylurea Compounds
  • Protein Kinase Inhibitors / adverse effects*
  • Protein Kinase Inhibitors / pharmacology
  • Pyridines / adverse effects*
  • Pyridines / pharmacology
  • Pyrroles / adverse effects*
  • Pyrroles / therapeutic use
  • Quality of Life
  • Receptors, Vascular Endothelial Growth Factor / antagonists & inhibitors
  • Sorafenib
  • Sunitinib


  • Benzenesulfonates
  • Indoles
  • Phenylurea Compounds
  • Protein Kinase Inhibitors
  • Pyridines
  • Pyrroles
  • Niacinamide
  • Sorafenib
  • Receptors, Vascular Endothelial Growth Factor
  • Sunitinib