HAND-FOOT SYNDROME FOLLOWING PROLONGED INFUSION OF HIGH-DOSES OF VINORELBINE

BACKGROUND. The authors reviewed the incidence of toxic skin reactions in patients with metastatic breast carcinoma (MBC) treated with vinor elbine as a continuous infusion. METHODS. A Phase I/II protocol was de signed in which vinorelbine was given as an 8-mg intravenous bolus fol lowed by a 96-hour CI of 7-14 mg/m(2)/day. Sixty patients were enrolle d in the study: all had MBC and had received prior chemotherapy, and t hey had no known dermatologic disorder. RESULTS. Hand-foot syndrome (H FS) developed in 4 of the 60 patients. Patient 1 started with vinorelb ine at 12 mg/m(2)/day. She developed typical HFS. In the second course , her dose was decreased to 11 mg/m(2)/day, but again she experienced HFS. In the third course, dexamethasone was added to the regimen, and no HFS was observed in the remaining six courses. Patient 2 started wi th a dose of 9 mg/m(2)/day. She received four courses without complica tions; but when the vinorelbine dose was escalated to 10 mg/m(2)/day. HFS developed. Patient 3 started with a vinorelbine dose of 14 mg/m(2) /day. She developed mucositis during the first two courses and HFS dur ing the third. Patient 4 received vinorelbine at a dose of 13 mg/m(2)/ day and developed significant HFS. All patients had complete dermatolo gic recovery. No toxic skin reactions were observed in 14 patients rec eiving vinorelbine doses of <10 mg/m(2)/day, whereas 4 of 46 treated a t 10-14 mg/m(2)/day developed HFS, suggesting a relationship of dose t o I-IFS occurrence. CONCLUSIONS, Longer infusions of vinorelbine are o ccasionally associated with HFS. The pathophysiology is not completely clear, but a relationship of HFS occurrence to dose is suggested. Ste roids were effective as prophylaxis in one patient. (C) 1998 American Cancer Society.