Published online Jul 28, 2018. doi: 10.3748/wjg.v24.i28.3155
Peer-review started: March 17, 2018
First decision: April 18, 2018
Revised: May 9, 2018
Accepted: June 22, 2018
Article in press: June 22, 2018
Published online: July 28, 2018
To investigate the relationship between the onsets of multikinase inhibitor (MKI)-associated hand-foot skin reaction (HFSR) and prognosis under intervention by pharmacists after the introduction of sorafenib.
We conducted a retrospective study involving 40 patients treated with sorafenib. Intervention by pharmacists began at the time of treatment introduction and continued until the appearance of symptomatic exacerbation or non-permissible adverse reactions. We examined the relationship between MKI-associated HFSR and overall survival (OS) after the initiation of treatment.
The median OS was 10.9 mo in the MKI-associated HFSR group and 3.4 mo in the no HFSR group, showing a significant difference in multivariate analysis. A multivariate analysis of the time to treatment failure indicated that the intervention by pharmacists and MKI-associated HFSR were significant factors. The median cumulative dose and the mean medication possession ratio were significantly higher in the intervention group than in the non-intervention group. A borderline significant difference was observed in terms of OS in this group.
Intervention by pharmacists increased drug adherence. Under increased adherence, MKI-associated HFSR was an advantageous surrogate marker. Intervention by healthcare providers needs to be performed for adequate sorafenib treatment.
Core tip: Sorafenib is an oral anticancer drug associated with a high incidence of adverse reactions. However, no studies have evaluated its therapeutic efficacy under improved adherence. A surrogate marker of significant improvement in overall survival under improved adherence in advanced hepatocellular carcinoma patients after the introduction of sorafenib was multikinase inhibitor-associated hand-foot skin reaction. Intervention by healthcare providers, including pharmacists specializing in cancer treatment, has improved patient adherence, contributing to the true response to sorafenib treatment.