Tolerability of Targeted therapy in MRCC

Hi, when we are talking about the targeted therapies in MRCC, we are always talking about the Sorafenib or Sunitinib, with minimal side effects. But in Indian context i have seen haldly any patient who is taking Sorafenib or sunitinib with 800mg a day i.e 400mg bid of sorafenib or 50 mg of sunitinib.
which mostly results in half of the dose in both the cases, so when the patient is not taking full dose of any of the therapy , what are the chances of PFS in both the cases, that will be reduced by half or the drug will work as placebo as the right dose was not taken.
What is the best option to manage the side effect particularly HFS , so that the patient can tolerate the full dose of therapy.We are always trying in India like the mointurising cream containg UREA, Vitamin B 12 composition, Advising the patients not to take any sun bath etc. some times using the antidermal therapies, or steroids but this hardly works.
How do do manage the sideeffects with these targetted therapies.

Thanks

[gupta47]

Rohit first of all please note that not necessaryly indian patient should take the international recommanded dose of these kind of drugs.some time depend up on the ps of the patient doctor may start with the lower dose in both the dtugs:like in sorafenib patient can start with 600mg or 400mg & in case of sunitinib its is 37.5mg or 25mg.
That does not lead to any effect on PFS.of the patient.
For management of side effects of these sort of drugs please refer to following web link:
http://www.nccn.org/professionals/physician_gls/PDF/fatigue.pdf
Regards.
Gupta47