Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Hand-Foot syndrome induced by sorafenib, a multitargeted tyrosine kinase inhibitor, in a patient with advanced renal cell carcinoma

진행된 신세포암 환아에게 sorafenib 투여시 발생한 Hand-Foot syndrome 1예

  • Lee, Seung Hyun (Department of Pediatrics, Research Institute of Clinical Medicine School of Medicine, Chonbuk National University) ;
  • Noh, Sung Hun (Department of Pediatrics, Research Institute of Clinical Medicine School of Medicine, Chonbuk National University) ;
  • Kim, Sun Young (Department of Pediatrics, Research Institute of Clinical Medicine School of Medicine, Chonbuk National University) ;
  • Jang, Kyu Yun (Department of Pathology, Research Institute of Clinical Medicine School of Medicine, Chonbuk National University) ;
  • Hwang, Pyoung Han (Department of Pediatrics, Research Institute of Clinical Medicine School of Medicine, Chonbuk National University)
  • 이승현 (전북대학교 의학전문대학원 소아과학교실) ;
  • 노성훈 (전북대학교 의학전문대학원 소아과학교실) ;
  • 김선영 (전북대학교 의학전문대학원 소아과학교실) ;
  • 장규윤 (전북대학교 의학전문대학원 병리학교실) ;
  • 황평한 (전북대학교 의학전문대학원 소아과학교실)
  • Received : 2008.03.26
  • Accepted : 2008.10.15
  • Published : 2009.01.15
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Abstract

Renal cell carcinoma (RCC) arising from epithelial cells of the renal tubules is a highly aggressive and malignant tumor in all ages; however, it rarely occurs in children. the standard treatment for RCC is radical nephrectomy with lymph node dissection when the tumor is localized and can be completely resected. Adjuvant chemotherapy, radiotherapy, and immunotherapy are used for pediatric patients with advanced RCC involving lymph nodes or metastatic lesions. Sorafenib is an oral, multikinase inhibitor that has recently been approved for use in metastatic RCC. Common toxicities that have been reported include dermatologic changes such as rash or desquamation and hand-foot skin reaction, diarrhea, fatigue, alopecia, and hypertension. In particular, hand-foot syndrome (HFS) an erythematous skin lesion of the palms and solesis most often caused by cytostatic chemotherapeutic agents. In this report, we have studied a 14-year-old female patient with hand-foot syndrome that occurred in association with sorafenib for the treatment of metastatic RCC. Furthermore, this case demonstrates that reversal of complications can be achieved by discontinuing the drug and intervention with topical steroids, vitamin E, and high-dose pyridoxine.

신세포암은 소아에서는 드물지만 모든 연령에 걸쳐 신 세뇨관의 상피세포에서 기인하는 침습적 악성 종양이다. 종양이 국소화 되어있다면 주위 림프절 절개와 함께 국소적 신절제술로 완벽히 제거될 수 있으나, 주위 림프조직을 침범한 경우나 전이 병변이 동반된 진행된 신세포암 에서는 보조 화학치료, 방사선치료 및 면역치료 등을 이용한다. Sorafenib는 경구, 다(多) kinase (multikinase) 억제제로서 최근 전이성 신장 암에 사용이 입증되었다. 그러나 설사, 피로, 탈모와 고혈압 등의 부작용과 발진이나 낙설 그리고 수족 피부 반응(hand-foot skin reaction)과 같은 피부변화 등이 보고되었다. 특히, 손바닥과 발바닥의 홍반 피부 병변을 보이는 수족 증후군(hand-foot syndrome, HFS)은 대부분 세포증식 억제 화학치료 약에 의해 야기된다. 손바닥 발바닥의 홍반성감각부전으로 알려진 수족 증후군은 저림과 고온의 물체에 대한 과민성 같은 감각이상의 전구증상 등을 특징으로 하며, 약 3- 4일 후 원위 지관절에 홍반과 동통을 수반한 양측에 대칭적 손바닥과 발바닥의 부종이 생긴다. 저자들은 14세 여아의 전이성 신세포암 치료에 sorafenib 사용 시 나타난 수족 증후군과 그에 대한 치료를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

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