HandFoot Skin Reaction is Associated with the Clinical Outcome in Patients with Metastatic Renal Cell Carcinoma Treated with Sorafenib

To elucidate whether HandFoot skin reaction could become a biomarker of clinical outcome in patients with metastatic renal cell carcinoma treated with sorafenib, we retrospectively examined the association between the HandFoot skin reaction and the clinical outcome in metastatic renal cell carcinoma patients treated with sorafenib. Thirty-six Japanese metastatic renal cell carcinoma patients treated with sorafenib were enrolled and divided into the groups with or without HandFoot skin reaction. Patient characteristics, best tumor response, progression-free survival and adverse events were investigated and compared between these two groups. A sorafenib-induced HandFoot skin reaction in metastatic renal cell carcinoma patients was observed at a significantly higher rate in patients in the favorable-risk group in the Memorial Sloan-Kettering Cancer Center risk classification, and with Eastern Cooperative Oncology Group Performance Status of one or less, prior nephrectomy, higher hemoglobin, lower lactate dehydrogenase and lower C-reactive protein. The mean best tumor response was significantly better in the group with HandFoot skin reaction (16.7) than that in the group without it (17.9; P 0.001). The median progression-free survival was significantly longer in the group with HandFoot skin reaction (4.6 months) than that in the group without it (1.5 months; P 0.002). In multivariate analysis, only HandFoot skin reaction was shown to be a predictive factor of progression-free survival (hazard ratio 0.312, P 0.010). A sorafenib-induced HandFoot skin reaction in metastatic renal cell carcinoma patients emerged at a significantly higher rate in patients in the favorable-risk group in the Memorial Sloan-Kettering Cancer Center risk classification and was significantly associated with best tumor response and progression-free survival, suggesting that HandFoot skin reaction might be an independent predictive factor for clinical outcome in metastatic renal cell carcinoma patients treated with sorafenib.