Proactive Management of Regorafenib-Associated AEs

Regorafenib is an anti-VEGF oral therapy that was approved by the Food and Drug Administration (FDA) in 2012 for use in patients with advanced colorectal cancer previously treated with chemotherapy. In 2013, the FDA approved it for patients with locally advanced, unresectable, or metastatic gastrointestinal stromal tumors who have been previously treated with imatinib and sunitinib. Unfortunately, regorafenib has been associated with certain adverse events (AEs), such as hand-foot skin reaction (HFSR) and hypertension.

Paulo Marcelo Hoff, MD, PhD, FACP, on Predicting Outcomes With First-Line Antiangiogenics Plus Chemotherapy in mCRC

Hoff is from the University of São Paulo, Brazil.

In their poster presentation at this year’s Oncology Nursing Society Congress, Robin Wachsman, RN, BSN, CCRN, OCN, BCRN, of West Cancer Center in Memphis, Tennessee, and Cathy Maxwell, RN, OCN, of Advanced Medical Specialties in Miami, Florida, provided an overview of strategies and best practices for the management of these and other AEs, to help ensure patients will adhere to therapy and achieve maximal therapeutic benefit.

Onset of AEs is typically observed in the first treatment cycle, the researchers note, and often eases later on, making it advisable for patients to be seen weekly during the first cycle of therapy. Wachsman and Maxwell stress that providing thorough education before treatment begins is essential in order to counsel patients on what to report and when to report it. They also note that HFSR can be managed successfully with such measures as moisturizers and avoiding trauma or unusual friction to the feet, and that hypertension is controllable with regular monitoring (See box).

Assisting Patients With Skin Reactions Associated With Targeted Therapies

The following suggestions may help avoid reactions and relieve them if they do happen:

• Encourage patients to communicate symptoms at the first sign of developing a reaction (such as a warm or burning sensation, pimples, nail fissures, or dry skin).
• Patients should be instructed to avoid the sun and to use (and frequently reapply) sunscreen with a high sun protection factor (SPF). Patients should also wear a broad-brimmed hat when outside and avoid direct sunlight between 10 AM and 4 PM.
• Soaps and laundry detergents with strong scents should be avoided. Likewise, patients should refrain from taking hot, long showers, and shower with lukewarm water instead.
• Applying a hypoallergenic moisturizer with no perfumes or preservatives (such as Vanicream, Aveeno, CeraVe, Cetaphil, and Eucerin) to dry areas within 15 minutes of showering or bathing can be helpful.
• Instruct patients to avoid anti-acne skin products containing alcohol, benzoyl peroxide, or retinoids, because they can be very drying to the skin.
• If needed, prescribe topical medicated creams, such as corticosteroids (alclometasone [Aclovate] or mometasone [Elocon, Momexin]) to effectively relieve symptoms of rash. In cases when the rash is very severe or covers a large area of the body, oral corticosteroids may be needed (such as prednisone or dexamethasone).
• Antibiotics in the tetracycline family (such as doxycycline and minocycline), usually taken for 2 to 4 weeks in pill form, are an effective therapy for rashes and nail tenderness when taking some targeted therapies.
• Whenever there is discharge of pus, sample for a culture to determine the appropriate antibiotic treatment.
• For very dry and flaky skin, a dermatologist may prescribe a moisturizer containing urea or lactic acid. Tell patients not to apply this type of moisturizer to sensitive or red areas of the skin.
• For HFSR, patients should use creams containing urea (carmol 20 or carmol 40), salicylic acid (Salex cream kit), or high potency corticosteroids (fluocinonide, clobetasol). Gel insoles may also help. Patients should be careful to avoid injury or putting too much weight on hands and feet, especially during the first 2 months of treatment
• For localized itching, prescribe a corticosteroid (alclometasone or mometasone) or an anesthetic (numbing medicine, such as lidocaine 2% or pramoxine) to be applied several times a day. For more generalized itching or itching that affects sleep, an antihistamine pill, such as cetirizine (Zyrtec) or diphenhydramine (Benadryl), can be prescribed

This information was adapted from Cancer.Net. Skin reactions to targeted therapies.http://www.cancer.net/navigating-cancer-care/side-effects/skin-reactions-targeted-therapies