Western Regional Blog – BC, YK, AB, NWT and Nunavut
TAKE-HOME MESSAGE Given the observation that elevated concentrations of doxorubicin are found in eccrine sweat glands in the palms and soles of patients receiving therapy, investigators explored the use of aluminum chlorohydrate-containing antiperspirants as a means to reduce the rate of palmar–plantar erythrodysesthesia (hand–foot syndrome; HFS) in patients receiving the peglyated liposomal form of the drug for metastatic breast cancer. Although not statistically significant, 6 patients on placebo developed HFS in contrast to only 1 patient in the treatment arm. The use of topical antiperspirants may reduce the incidence of HFS in patients receiving doxorubicin. – Chris Tully, MD
Background Elevated concentrations of doxorubicin are found in eccrine sweat glands of the palms and soles. We therefore evaluated an antiperspirant as preventive treatment for palmar–plantar erythrodysesthesia (hand–foot syndrome) in patients with metastatic breast cancer treated with pegylated liposomal doxorubicin.
Patients and Methods An antiperspirant containing aluminum chlorohydrate or placebo cream was applied to the left or right hand and foot in a double-blinded manner (intra-patient randomization). The primary endpoint was the rate of grade 2 or 3 palmar–plantar erythrodysesthesia. A secondary endpoint was the patient-reported symptom burden (tingling, numbness, pain, or skin problems). Using McNemar’s matched pairs design, 53 patients were needed to detect a 20% difference between the treatment and placebo sides with a significance level of 5% and power of 90%.
Results Grade 2 or 3 PPE occurred in 30 (58%) of 52 evaluable patients; in six patients adverse effects occurred on the placebo side but not on the treatment side, whereas one patient developed palmar–plantar erythrodysesthesia on the treatment side only (P = 0.07). Four patients developed grade 2 or 3 palmar–plantar erythrodysesthesia on their foot on the placebo side but not on the treatment side
(P = 0.05). In the cohort with grade 2 or 3 palmar–plantar erythrodysesthesia there was a trend towards fewer dermatologic symptomatologies with the active treatment (P = 0.05), and no difference for other adverse events.
Conclusion Using topical aluminum chlorohydrate as an antiperspirant appears to reduce the incidence of grade 2 or 3 palmar–plantar erythrodysesthesia following pegylated liposomal doxorubicin chemotherapy for metastatic breast cancer.