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HFSR — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyHFSRSCE Medical Oncology

A 63-year-old man on regorafenib for refractory colorectal cancer develops severe hand-foot skin reaction (HFSR) with painful thick calluses and blistering on weight-bearing areas of the feet. He is unable to walk. What is the management?

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Correct answer: E — Hold regorafenib, start aggressive skin care, and resume at a reduced dose (120 mg then 80 mg)

HFSR with multi-kinase inhibitors (regorafenib, sorafenib, cabozantinib) differs from capecitabine hand-foot syndrome in distribution (pressure/friction areas) and histology. Grade 3 HFSR requires treatment interruption until improvement to ≤grade 1, then dose reduction (regorafenib: 160→120→80 mg). Proactive skin care (urea-based creams, pressure-relieving footwear, callus management) reduces severity. This is a class effect of VEGFR-targeting multi-kinase inhibitors.

Reference: BNF Regorafenib monograph; ESMO 2024 Supportive Care Guidelines; McLellan et al Ann Oncol 2015