Toceranib-Associated Palmar-Plantar Erythrodysesthesia in a Dog with Renal Cell Carcinoma

초록

This case report describes a dog with high-grade renal cell carcinoma that developed recurrent palmar-plantar erythrodysesthesia syndrome (PPES), hypopigmentation, and hyperkeratotic footpad lesions during adjuvant treatment with toceranib phosphate. The patient exhibited dose-dependent dermatological reactions and proteinuria, which repeatedly improved upon drug withdrawal but recurred after reintroduction. Comprehensive dermatological and systemic evaluations ruled out infectious or allergic etiologies, and adverse events were graded using the Veterinary Cooperative Oncology Group Common Terminology Criteria for Adverse Events (VCOG-CTCAE) v2 criteria. The clinical features closely resemble hand-foot skin reaction (HFSR), which has been widely reported in human oncology with multitarget tyrosine kinase inhibitors (TKIs). Notably, dermatological toxicity was successfully controlled through dose-interval modification from every other day to every 3-4 days, without requiring permanent discontinuation of toceranib. This case highlights the underrecognized potential of TKI-associated cutaneous toxicity in dogs, supports the applicability of human National Cancer Institute’s CTCAE–based management strategies to veterinary patients, and underscores the need for evidence-based guidelines for monitoring and managing palmar-plantar erythrodysesthesia syndrome (PPES)/ hand-foot skin reaction (HFSR)-like reaction in canine oncology. © The Korean Society of Veterinary Clinics.

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