What Patients Can Do

Patient education on the potential drug-related cutaneous side effects associated with multikinase inhibitors is key for successful management and prevention of these side effects. Cumulative experience arising from clinical trials and clinical practice has demonstrated that pre-emptive rather than reactive therapeutic strategies are more efficient in controlling the different side effects caused by these agents.

In the case of pre-emptive measures not being sufficient to avoid the appearance of adverse events, early initiation of appropriate effective therapeutic measures is crucial for adverse event management and to maintain multikinase inhibitor dose intensity.

In this regard, active participation of the patient is recommended to encourage rapid establishment of contact with the patient’s healthcare provider upon the initial appearance of symptoms. Such a strategy will allow for appropriate treatment of the problem and will lead to a faster recovery from the side effect, and will also help avoid any dose interruptions.


Patients should take extra care with their skincare and avoid any identified conditions or irritants that may worsen the rash, as well as notifying their healthcare team early upon symptom onset.

Hand-Foot Skin Reaction (HFSR)

Patient education about HFSR prior to starting therapy and guidance on skin care and protection is another strategy for prevention of HFSR.1,2 Patients should be encouraged to maintain frequent communication with their healthcare team to ensure symptoms are detected and managed as soon as possible.3,4 Patients should avoid pressure and friction on the skin, and avoid traumatic activity, as well as consider wearing gloves or protective socks if a potentially traumatic activity is planned.

Dry Skin and Pruritus

Patients should be advised to use tepid water, minimise showering, avoid soaps, and use topical emollients (fragranced or unfragranced, whichever the patient feels comfortable with) rather than ointments to avoid occlusion of the follicles.5 Based on the authors’ experience, use of moisturisers immediately after bathing may allow better hydration of the skin and vigorous drying of the skin should be avoided to minimise irritation.

Nail Changes

Patient education and pre-emptive strategies are important for managing nail abnormalities.5 To minimise pressure, trauma and friction on the nail, patients should wear wide shoes and avoid the following: biting nails, cutting nails too short (especially toe nails) or damaging the surrounding skin.


Patients should practice good oral hygiene and effective dental care.3


Patients should be alerted to the likelihood of photosensitivity and should employ effective photoprotection strategies.

Keratoacanthomas and Squamous Cell Carcinomas

Patients should be educated about this potential toxicity and should monitor their skin to potentially allow earlier identification of these lesions, as well as to avoid sun exposure or underwent protective measures against this stress factor.5


1Anderson R, et al. Search for evidence-based approaches for the prevention and palliation of hand-foot skin reaction (HFSR) caused by the multikinase inhibitors (MKIs). Oncologist. 2009;14:291–302.
2Walko CM, Grande C. Management of common adverse events in patients treated with sorafenib: nurse and pharmacist perspective. Semin Oncol. 2014;41:S17–S28.
3De Wit M, et al. Prevention and management of adverse events related to regorafenib. Support Care Cancer. 2014;22:837–846.
4Lacouture ME, et al. Evolving strategies for the management of hand-foot skin reaction associated with the multitargeted kinase inhibitors sorafenib and sunitinib. Oncologist. 2008;13:1001–1011.
5Balagula Y, Lacouture ME, Cotliar JA. Dermatologic toxicities of targeted anticancer therapies. J Support Oncol. 2010;8:149–161.

Last update: 22 August 2014