Prevention strategies in palmar–plantar erythrodysesthesia onset: The role of regional cooling

Objective.Palmar–plantar erythrodysesthesia (PPE) is a characteristic cutaneous toxicity associated with pegylated liposomal doxirubicin (PLD). Different therapies have been proposed to alleviate PPE onset. We performed a prospective study to evaluate preventive strategies to reduce PPE incidence in patients treated for gynecologic cancers.Methods.Fifty-three patients were treated from 2001 to 2006 with PLD as single agent therapy or in combination with carboplatin or paclitaxel. PLD dosages were in the range of 30–50 mg/m2 every 21–28 days. All patients received premedication with dexamethasone and pyridoxine. Twenty-eight patients received application of ice packs on extremities during PLD infusion.Results.PPE was observed in 11 patients (20.8%). PLD administration as single agent or in combination and schedule of PLD therapy did not affect PPE incidence. A significant reduction in PPE onset was observed if PLD dosage was 30–35 mg/m2 (p = 0.03) and when patients were submitted to regional cooling protocol (p = 0.0097).Conclusions.The use of ice packs around wrists and ankles is a simple and well tolerated prevention strategy and its efficacy is demonstrated in this study.