Oral dexamethasone attenuates Doxil®-induced palmar-plantar erythrodysesthesias in patients with recurrent gynecologic malignancies

Objective. The aim of this study is to evaluate the effect of oral dexamethasone in attenuating palmar-plantar erythrodysesthesias (PPE) in Doxil®-treated patients for gynecologic malignancies. Methods. An IRB-approved prospective case study was conducted in patients with recurrent gynecologic malignancies who were treated with Doxil® (50 mg/m ²) on a 28-day cycle. Patients experiencing grades II-IV PPE were delayed until resolution then retreated without dose reduction and with a tapering oral dexamethasone regimen (8 mg BID days -1 to 4; 4 mg BID day 5; 4 mg day 6). Standard treatment for grades II-IV PPE in those not receiving dexamethasone was weekly dose delay until resolution of symptoms up to 2 weeks. If resolution occurred within 3 weeks of delay, a 25% dose reduction was made. Persistent grades III/IV PPE resulted in withdrawal of Doxil®. Results. Twenty-three patients (ovarian-16, uterine-7) were treated between January 1998 and December 2000. The median number of cycles administered was 5 (range 1-20). Nine patients (39%) developed grades II-IV PPE. All nine patients received more than five cycles of Doxil®. The median time to PPE was 3 cycles (range 2-5). Six out of nine PPE patients received scheduled dose dexamethasone. All six had complete or near complete resolution of PPE and all continued treatment without subsequent dose modification. All three of the nine PPE patients not receiving dexamethasone required treatment delays and were dose reduced. Conclusion. Oral dexamethasone is effective in attenuating or eliminating Doxil®-induced PPE. The use of the dexamethasone regimen prevents treatment delay and dose reduction.