Table 2.

Skin toxicity grading scale

Grade	Skin toxicity	Occurrence	Suggested modification
1	Numbness, dysesthesia, paresthesia, tingling, painless swelling, erythema, or discomfort of the hands or feet that does not disrupt the patient’s normal activities	Any occurrence	Continue treatment with sorafenib and consider topical therapy for symptomatic relief
2	Painful erythema and swelling of the hands or feet and/or discomfort affecting the patient’s normal activities	First occurrence	Continue treatment with sorafenib and consider topical therapy for symptomatic relief; if no improvement within 7 days, see below
		No improvement within 7 days or second or third occurrence	Interrupt sorafenib treatment until toxicity resolves to grade 0–1; when resuming treatment, decrease dose by one dose level (400 mg daily or 400 mg every other day)
		Fourth occurrence	Discontinue treatment
3	Moist desquamation, ulceration, blistering, or severe pain of the hands or feet, or severe discomfort that causes the patient to be unable to work or perform activities of daily living	First or second occurrence	Interrupt sorafenib treatment until toxicity resolves to grade 0–1; when resuming treatment, decrease dose by one dose level (400 mg daily or 400 mg every other day)
		Third occurrence	Discontinue treatment

From Nexavar® (sorafenib) [package insert]. West Haven, CT: Bayer Healthcare, 2005.