Clinical and literature case analysis of hand-foot syndrome induced by apatinib
Department of Pharmacy, Kailuan General Hospital, Hebei Province, Tangshan 063001, China; Department of Pharmacy, Tangshan Hongci Hospital, Hebei Province, Tangshan 063006, China; Department of Pharmacy, People′s Hospital of Zunhua, Hebei Province, Zunhua 064200, China
Abstract：Objective To explore the clinical characteristics of hand-foot syndrome（HFS） induced by apatinib. Methods Case reports of HFS induced by apatinib were collected through sear- ching PubMed, VIP, CNKI, and Wanfang databases (up to March 20, 2019). The clinical characteristics of HFS induced by apatinib were analyzed according to the literature above and the information from 2 related patients admitted to Kailuan General Hospital. Results A total of 16 patients were enrolled in the study, including 9 males and 7 females, aged (62±16) years. Apatinib was applied for gastric cardia cancer in 4 patients, lung cancer in 4 patients, ovarian cancer in 2 patients, thyroid cancer in 2 patients, and other malignant tumors in 4 patients. And it was used alone in 11 patients and in combination with other antineoplastic agents in 5 patients. Dosages of apatinib included 850-mg/d in 3 patients, 500-mg/d in 6 patients, 425-mg/d in 1 patient, and 250-mg/d in 6 patients (the dose was increased to 500-mg/d in 2 patients after 1 and 2 weeks of administration, respectively). According to the severity, HFS was classified as grade 1 in 2 patients (12.5%), grade 2 in 6 patients (37.5%), and grade 3 in 8 patients (50.0%). Except that the time from application of apatinib to HFS occurrence was not known in 1 patient, the median time from medication to HFS occurrence was 3 (1-11) weeks in other 15 patients, and 10 (66.7%) of them developed HFS within 3 weeks of administration. In addition to the skin lesions of HFS, the skin/mucous membrane damage also appeared on perianal area, genital, axillary fossa, groin, and mouth in 5 patients. Among the 16 patients, 13-had other adverse events, including hypertension in 10 patients (62.5%). The symptoms of 8 patients with HFS of grade 1-2 mostly improved or were tolerable after symptomatic treatments. And in detail, 3 patients′ symptoms had no effect on the treatment of apatinib, 4 patients could tolerate a reduced dose or re-medication after a pause, and 1 patient stopped medication. Symptomatic treatment effects were poor in 8 patients with grade 3 HFS, 4 of whom stopped apatinib because of the serious HFS and 3 of whom died. Conclusions The HFS induced by apatinib usually occurs within 3 weeks after administration, which can involve many parts of the body except for the skin of hands and feet, and are accompanied with hypertension mostly. HFS symptoms can be relieved by symptomatic treatments, reasonable dose reduction, or drug withdrawal in most patients.
韩梅，葛明，刘月娥. 阿帕替尼致手足综合征临床及文献病例分析[J]. 药物不良反应杂志, 2020, 22(4): 233-238.
Han Mei, Ge Ming, Liu Yuee. Clinical and literature case analysis of hand-foot syndrome induced by apatinib. Adverse Drug Reactions Journal, 2020, 22(4): 233-238.
