Topical DMSO treatment for pegylated liposomal doxorubicin-induced palmar-plantar erythrodysesthesia

• Published in: Cancer chemotherapy and pharmacology 1999, Vol.44 (4), p.303-306
• Main Authors: LOPEZ, A. M, WALLACE, L, DORR, R. T, KOFF, M, HERSH, E. M, ALBERTS, D. S
• Format: Article
• Language: English
• Subjects: Administration, Topical; Anti-Inflammatory Agents - therapeutic use; Antineoplastic Agents - adverse effects; Biological and medical sciences; Dimethyl Sulfoxide - therapeutic use; Doxorubicin - adverse effects; Drug toxicity and drugs side effects treatment; Erythema - chemically induced; Erythema - drug therapy; Female; Foot; Hand; Humans; Liposomes; Male; Medical sciences; Middle Aged; Miscellaneous (drug allergy, mutagens, teratogens...); Paresthesia - chemically induced; Paresthesia - drug therapy; Pharmacology. Drug treatments; Polyethylene Glycols - administration & dosage; Syndrome
• ISSN: 0344-5704; 1432-0843
• DOI: 10.1007/s002800050981

Chemotherapeutic regimens that utilize fluorouracil, cytarabine, and doxorubicin have been shown to cause a dermatologic syndrome known as hand-foot syndrome, or palmar-plantar erythrodysesthesia syndrome (PPES). Pegylated liposomal doxorubicin has proven effective in the treatment of AIDS-related Kaposi's sarcoma, ovarian cancer refractory to platinum and paclitaxel therapies, and metastatic breast cancer. In a study of the treatment of refractory epithelial cell ovarian cancers with lipozomal doxorubicin utilizing intravenous doses of 50 mg/m(2) every 3 weeks, grade 3 PPES was observed in 29% of patients (10/35) and required dose reductions and/or dose delay after a median of three therapy cycles. Current methods to prevent pegylated liposomal doxorubicin-induced PPES include dose reduction, lengthening of the drug administration interval and ultimately, drug withdrawal. Topical 99% dimethylsulfoxide (DMSO) also has shown strong activity in treating tissue extravasation reactions during intravenous administration of doxorubicin. Two patients undergoing chemotherapy with pegylated liposomal doxorubicin, 50 mg/m(2) every 4 weeks, developed grade 3 PPE after three cycles. Their PPES resolved over a period of 1 to 3 weeks while receiving topical 99% DMSO four times daily for 14 days. While these results are promising, patients must be treated in a prospective study of this topical DMSO formulation to definitively document its therapeutic efficacy.