Range of Possible Side Effects
You have probably been down this road before—you are well aware that chemotherapy drugs can cause a variety of side effects. Many of the side effects associated with DOXIL are mild to moderate and may be minimized.

It is still important to understand your risks. Side effects are a serious matter, but many can be prevented, managed and often reversed by delaying or reducing doses.

Hand-Foot Syndrome
You may experience a skin reaction called hand-foot syndrome (HFS), also called palmar-plantar erythrodysesthesia (PPE). See Managing Side Effects for hints on how to manage and help prevent symptoms.

Hand-foot syndrome usually occurs on the palms of the hands and soles of the feet. However, it can also occur on other parts of the body where your clothes may be tight or where friction, pressure, rubbing, warmth, and/or sweating occur.

You or your caregiver should check regularly for signs of skin irritation and hand-foot syndrome. If you already have peripheral neuropathy (numbness or tingling in the hands and feet) from previous treatment or other conditions, you may not notice the symptoms as easily.

Common signs and symptoms of hand-foot syndrome may include:

• Redness
• Rash
• Pain or tenderness
• Swelling
• Tingling, burning, or itching
• Flaking or peeling of the skin
• Small blisters or sores

In most patients, the reaction is mild and improves in one to two weeks without a delay in therapy. However, hand-foot syndrome can become severe in some patients and may require either delaying or stopping therapy.

At the first sign of any of these symptoms, please tell your doctor or nurse immediately. They may have specific suggestions to help you reduce the severity of hand-foot syndrome. Because its frequency and severity are usually associated with the chemotherapy dose and/or schedule, hand-foot syndrome may be treated with a delay and/or reduction in therapy until the symptoms are resolved. A delay or reduction in dose typically does not reduce the effectiveness of treatment.

Stomatitis
Another skin-related reaction is stomatitis, a mouth irritation characterized by inflammation or sores. Stomatitis may be prevented by avoiding certain foods and beverages. Your doctor or nurse can provide you with specific guidelines to help prevent stomatitis. For example, you might be told to suck on ice chips or sip cool beverages as often as possible.

Some common symptoms of stomatitis include:

• Mouth sores
• Dry, swollen tongue
• Pain or burning in the mouth
• Difficulty swallowing

Hair Loss
Hair loss, or alopecia, is typically mild with DOXIL therapy. When it does occur, the hair usually grows back after completion of therapy. In a clinical study, some hair loss occurred in 19.2% of patients.

Nausea and Vomiting
Nausea and vomiting are usually mild and may be prevented with medication.