Table 2.
| A. Maculopapular and intertriginous rashes. | |
|---|---|
|
| |
| Severity (CTCAE v.4) |
Intervention |
| Grade 0 | Gentle skin care instructions given |
|
| |
| Grade 1 | Continue drug at current dose and monitor for change in severity |
|
| |
| Topical low/moderate-strength steroid to affected areas bid1 AND | |
| If infection is suspected, apply topical antibiotic or anti-fungal agent | |
|
| |
| Reassess after 2 weeks (either by healthcare professional or patient self-report); if reactions worsen proceed to next step | |
|
| |
| Grade 2 | Continue drug at current dose and monitor for change in severity; obtain bacterial/viral/fungal cultures if infection is suspected; continue treatment of skin reaction with the following: |
|
| |
| Topical moderate-strength steroid to affected areas bid1 AND | |
| If infection is suspected, apply topical antibiotic or anti-fungal agent | |
|
| |
| Reassess after 2 weeks (either by healthcare professional or patient self-report); if reactions worsen or do not improve proceed to next step | |
|
| |
| Grade 3 | Interrupt treatment until severity decreases to Grade 0–1; obtain bacterial/viral/fungal cultures if infection is suspected; and continue treatment of skin reaction with the following: |
|
| |
| Topical moderate-strength steroid to affected areas bid1 AND | |
| If infection is suspected, apply topical antibiotic or anti-fungal agent | |
|
| |
| Reassess after 2 weeks; if reactions worsen or do not improve, consider dose interruption or discontinuation per protocol and switch to another antineoplastic agent2 | |
| B. Palmar plantar or dorsal Hand Foot Syndrome/ PATEO syndrome. | |
|---|---|
|
| |
| Severity (CTCAE v.4) |
Intervention |
| Grade 0 | Gentle skin care instructions given; avoid irritation to the hands and feet |
|
| |
| Grade 1 | Continue drug at current dose and monitor for change in severity |
|
| |
| Topical high-potency steroid bid | |
|
| |
| Reassess after 2 weeks (either by healthcare professional or patient self-report); if reactions worsen proceed to next step | |
|
| |
| Grade 2 | Continue drug at current dose and monitor for change in severity |
|
| |
| Topical high-potency steroid bid AND | |
| Pain control with NSAIDs/GABA agonists/narcotics AND | |
| +/− oral steroids (dexamethasone/prednisone) | |
|
| |
| Grade ≥3 or intolerable Grade 2 | Reassess after 2 weeks (either by healthcare professional or patient self-report); if reactions worsen or do not improve proceed to next step |
|
| |
| Interrupt treatment until severity decreases to Grade 0–1, and continue treatment of skin reaction with the following: | |
|
| |
| Topical high-potency steroid bid AND | |
| pain control with NSAIDs/GABA agonists/narcotics | |
| +/− oral steroids (dexamethasone/prednisone) | |
|
| |
| Reassess after 2 weeks; if reactions worsen or do not improve, consider dose interruption or discontinuation per protocol and switch to another antineoplastic agent1 | |
1
Oral antihistamines can be also prescribed
2
If applicable, switch docetaxel to paclitaxel (or vice versa)
1
If applicable, switch docetaxel to paclitaxel (or vice versa)