Challenges Associated with Tyrosine Kinase Inhibitor Therapy for Metastatic Thyroid Cancer

Table 3

Suggested dose modification for skin toxicity for sorafenib [8].

Skin toxicity grade	Occurrence	Suggested dose modification
Grade 1: numbness, dysesthesia, paresthesia, tingling, painless swelling, erythema or discomfort of the hands or feet which does not disrupt the patient’s normal activities	Any occurrence	Continue sorafenib and consider topical therapy for symptomatic relief
Grade 2: Painful erythema and swelling of the hands or feet and/or discomfort affecting the patient’s normal activities	1st occurrence	Continue sorafenib and consider topical therapy for symptomatic relief. If no improvement within 7 days, see below
	No improvement within 7 days or 2nd or 3rd occurrence	Interrupt sorafenib until toxicity resolves to grade 0-1. When resuming treatment, decrease sorafenib dose by one dose level (400 mg daily or 400 mg every other day)
	4th occurrence	Discontinue sorafenib treatment
Grade 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	1st or 2nd occurrence	Interrupt sorafenib until toxicity resolves to grade 0-1. When resuming treatment, decrease sorafenib dose by one dose level (400 mg daily or 400 mg every other day)
	3rd occurrence	Discontinue sorafenib treatment