Review Pegylated liposomal doxorubicin-associated hand–foot syndrome: Recommendations of an international panel of experts Roger von Moos a, *, Beat J.K. Thuerlimann b , Matti Aapro c , Daniel Rayson d , Karen Harrold e , Jalid Sehouli f , Florian Scotte g , Domenica Lorusso h , Reinhard Dummer i , Mario E. Lacouture j , Ju ¨ rgen Lademann k , Axel Hauschild l a Medical Oncology, Kantonsspital Graubu ¨ nden, Loestrasse 170, Chur 7000, Switzerland b Oncology, Kantosspital, Senology Center of Eastern Switzerland, St. Gallen CH-90007, Switzerland c Oncology, Clinique De Genolier, 1 Rte du Muids, Genolier CH-1272, Switzerland d Medical Oncology, QEII Health Science Centre, 1278 Tower Road, 4th Floor Bethune Building, Halifax, NS, Canada B3H 2Y9 e Oncology, Mount Vernon Cancer Center, Rickmansworth Road, Northwood, Middlesex HA6 2RN, United Kingdom f Gynecology and Obstetrics, University Hospital Charite, Augustenberger Platz 1, Berlin 13353, Germany g Oncology, Hopital Europeen G. Pompidou, 20-40 Rue LeBlanc, Paris 75015, France h Oncology, Universita Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome 00168, Italy i Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zu ¨ rich CH-8091, Switzerland j Dermatology, Northwestern University, 676 North Street Clair, Ste 1600, Chicago, IL 60611, United States k Dermatology, Charite University Hospital, Campus Mitte, Berlin 10098, Germany l Dermatology, University Hospital (UKSH), Schittenheimstrasse 7, Kiel D-24105, Germany ARTICLE INFO Article history: Received 31 October 2007 Accepted 28 January 2008 Available online 10 March 2008 Keywords: Hand–foot syndrome Palmar–plantar erythrodysesthesia Pegylated liposomal doxorubicin Recommendations ABSTRACT Background: Hand–foot syndrome (HFS) is dose-limiting and the most common cumulative toxicity associated with pegylated liposomal doxorubicin (PLD). It can cause considerable discomfort and lead to therapy interruption. Numerous approaches to HFS management have been reported, but there is no consensus. Methods: Published literature (identified via Medline and internet search) and expert expe- rience regarding HFS and its pathogenesis, incidence, risk factors, prevention and treat- ment in patients undergoing treatment with PLD were collected and reviewed by a panel of experts. A consensus technique was used to develop recommendations. Findings: The pathogenesis of PLD-associated HFS has been recently elucidated. Systems used to grade, prevent and treat HFS in individuals treated with PLD vary widely. A random- ised clinical study demonstrated that PLD dose intensity reduction can prevent HFS. While there is limited literature support, patient education and supportive measures were endorsed by the expert panel as effective strategies for HFS prevention and treatment. An easy to use HFS grading and management algorithm was developed, early signs and symptoms of HFS outlined and specific recommendations for supportive care developed. Interpretation: The paucity of data on the management of PLD-associated HFS led the expert panel to develop consensus-based recommendations. Patient education and supportive 0959-8049/$ - see front matter Ó 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejca.2008.01.028 * Corresponding author: Tel.: +41 81 2566646; fax: +41 81 2566640. E-mail address: roger.vonmoos@onkologie.li (R. von Moos). EUROPEAN JOURNAL OF CANCER 44 (2008) 781 – 790 available at www.sciencedirect.com journal homepage: www.ejconline.com