Apatinib mesylate tablets-induced hand-foot skin reaction: report of two cases

Abstract

Two male patients (patient 1, 54 years old; patient 2, 63 years old) were treated with apatinib mesylate tablets (apatinib) for adenocarcinoma of cardia and gastric fundus and left lung cancer, respectively. Patient 1 developed erythema and swelling on the extremities, perianal, and perigenital on day 22 after taking apatinib (850 mg/d). Apatinib-induced hand-foot skin reaction (HFSR) was considered. Then apatinib was discontinued, oral vitamin B6 and topical external vitamin E cream were given. After withdrawal of apatinib, his skin symptoms alleviated, and apatinib (750 mg/d) was re-given on day 7 after withdrawal. On day 57 after the resumption of apatinib, the patient′s skin symptoms worsened and the medication was discontinued again. Afterwards, apatinib was given and then discontinued for 2 times (first 500 mg/d and then 250 mg/d). Because the symptoms aggravated after medication and alleviated after discontinuation, apatinib treatment was terminated finally. Patient 2 developed skin erythema, swelling, and pain on the palms and soles on day 35 after apatinib treatment at a dose of 500 mg/d. On day 85, he developed skin desquamation and circular keratosis of hands and feet, scattered erythema with desquamation in axilla, perianal region and groin, and increased pain in the skin lesions. Apatinib-induced HFSR was diagnosed. Apatinib was discontinued and symptomatic treatments were given. On day 17 of drug withdrawal, his skin symptoms improved and apatinib (500 mg/d) was given again. About 2 weeks later, the patient′s skin symptoms aggravated again, and the drug was discontinued. Key words: Antineoplastic agents; Apatinib; Hand-foot skin reaction