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Re:Metastatic Bladder Cancer, treatment side effects
My husband has bladder metastatic cancer and is undergoing treatment with Efartinib. The side effects are brutal, mouth sores, excruciating pain in the soles of the feet and losing his nails. Does anybody know how to cope with the pain in the soles of his feet and the mouth sores?
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I have never taken Eradafitnib, so I cannot tell from my experience. But I know someone who have had Erdafitnib.
I am sorry to hear that your husband is experiencing side effects BALVERSA® (erdafitinib). BALVAERSA is a so-called FGFR kinase inhibitor. It is like a switch to start a cell division cycle. FGFR of cancer cells are often defective, so cancer cells are constantly dividing and duplicating more cancer cells. BALVAERSA stops producing more cancer cells by disabling the FGFR switch.
Side effects happen because normal cells of other tissues, especially fast growing tissue such as nails, have many FGFRs because they need to grow faster. It is also known that FGFR have been detected in various cell types within the oral cavity, which I think is the cause of mouth soreness.
</div><div>Pain in the soles seems to be palmar–plantar erythrodysesthesia syndrome (PPES). PPES typically affects the palms of the hands and the soles of the feet, causing a range of symptoms from mild redness and swelling to severe pain and blistering. PPES is also mentioned as side effect of FGFR kinase inhibitor.
</div>In terms of treatment, I think urologist and dermatologist should be consulted. Below are information I have found on internet. The information is only from reputable medical professionals.
Below recommendations are mentioned in a published paper
Dermatologic Adverse Events Associated with Selective Fibroblast Growth Factor Receptor Inhibitors: Overview, Prevention, and Management Guidelines
https://theoncologist.onlinelibrary.wiley.com/doi/full/10.1002/onco.13552
Nail Changes
Counseling and education on the potential for nail changes are essential before initiation of treatment with FGFR inhibitors. Preventive strategies include avoidance of prolonged contact with water, repeated trauma, friction, and pressure on nails and nail beds. The use of protective gloves and limiting use of nail polish removers and nail hardeners is also helpful. Patients are also advised to avoid biting nails or cutting nails too short and to use topical emollients and loose-fitting socks and footwear. Preventive correction of nail curvature may be considered.
PPES
Prevention strategies for PPES include prophylactic removal of hyperkeratotic areas, application of moisturizing cream containing urea ≥10%, pedicures, and cushioning of callused areas using soft or padded shoes [48]. Other preventive tactics include avoidance of activities that cause force or rubbing on the hands and feet during the first 6 weeks of treatment and limiting contact with harsh chemicals and sources of heat, such as sitting in saunas or the sun.
Management of PPES consists of keratolytic agents such as urea ≥ 10% for grade ≥ 1 PPES, with addition of high-potency topical steroids such as fluocinonide 0.05% for grade ≥ 2 symptoms.
Stomatitis / Mouth Sore
Preventive strategies include undertaking dental work aimed at eliminating existing tooth and gum disease before the start of treatment and education regarding the importance of thorough and frequent cleaning of the oral cavity. Avoidance of salty, spicy, or citrus-based foods, as well as hot beverages, may help prevent stomatitis.
Upon emergence of grade 1 or 2 stomatitis, dexamethasone 0.5 mg/5 mL elixir is recommended; an augmented betamethasone dipropionate 0.05% gel applied to gauze and held against the affected surface may also assist in alleviating symptoms.
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