UICC World Cancer Congress 2006

Objective: A commonly administered regimen for node positive breast cancer involves dose dense therapy, with four cycles of doxorubicin (A) and cyclophosphamide (C) followed by paclitaxel (T), once every two weeks, with either daily granulocyte colony-stimulating factor (G-CSF/ filgrastim) or once per cycle pegylated G-CSF (pegfilgrastim). Hand Foot Syndrome (HFS) has not previously been well described with this regimen.

Methods: This case series reports the observation of HFS occurring in a series of breast cancer patients receiving the above noted adjuvant chemotherapy at a tertiary care center and investigates the likely etiology.

Results: Ten patients developed HFS while receiving dose dense chemotherapy, either AC or T, with pegfilgrastim support. The syndrome started 0-2 days following pegfilgrastrim administration with a tingling sensation in the palms or soles, followed by well-defined symmetric swelling, erythema and desquamation over the next 1-3 days. It resolved within several days in nine out of ten patients with conservative management. One patient with concomitant diabetes mellitus required hospitalization for local treatment of the lesions and intravenous analgesics for pain control. In all cases where pegfilgrastim was discontinued, the syndrome did not recur when chemotherapy was restarted without pegfilgrastim.

Conclusion: HFS can occur in breast cancer patients treated with either AC or T, given in a dose dense manner followed by pegfilgrastim. The observation that HFS did not recur following discontinuation of pegfilgrastim suggests that pegfilgrastim is the causative agent. Further studies are needed to confirm these findings.