Sunitinib-Induced Hand-Foot Skin Reaction: A Case Report

Hand-foot skin reaction (HFSR) is a common dermatological adverse effect of multikinase inhibitors like sunitinib that can impair quality of life and disrupt treatment continuity. We report a 52-year-old male with metastatic renal cell carcinoma who developed Common Terminology Criteria for Adverse Events (CTCAE v5.0) Grade 2 sunitinib-induced HFSR presenting as painful palmar-plantar hyperpigmented lesions and bullae during his third treatment cycle (50 mg/day; two weeks on, one week off). Sunitinib was temporarily held, and multimodal supportive management (including topical corticosteroids, analgesics, and skin barrier care) was initiated. Following complete resolution of lesions, sunitinib was safely resumed at a reduced dose of 37.5 mg daily with no recurrence of HFSR, maintaining oncological therapy. This case suggests that temporary drug interruption combined with targeted supportive care and step-down dose rechallenge may serve as a manageable strategy for Grade 2 HFSR in select patients. However, the efficacy and safety of this approach cannot be generalized, and further studies are needed to establish standardized rechallenge protocols.