1594P - Prevention strategies for chemotherapy induced hand-foot syndrome: a meta-analysis of prospective randomised trials

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Complications/Toxicities of Treatment
Presenter Ligia Traldi Macedo
Authors L. Traldi Macedo1, A. Sasse2
  • 1Departamento De Oncologia Clínica, State University of Campinas (UNICAMP), 13083-970 - Campinas/BR
  • 2Cevon Centre For Evidences In Oncology, UNICAMP - Universidade Estadual de Campinas, BR-13083-887 - Campinas/BR



Hand-foot syndrome (HSF) is a distinctive adverse event relatively frequent to some chemotherapeutic agents as capecitabine, pegylated liposomal doxorubicin, docetaxel or sorafenib, and often recognized as a dose-limiting reaction. The prevention of HSF would be therefore crucial to avoid treatment interruptions, and many studies have been developed in the attempt to reach this purpose. The aim of this meta-analysis is to analyze the clinical efficacy of current prevention strategies.


A wide search through PubMed/MEDLINE was performed using the terms related to hand-foot syndrome, erythrodysesthesia and random in all fields. ASCO and ESMO Meeting Abstracts from 2000 to 2011 were also scanned. Randomized trials comparing intervention versus observation or placebo were selected and had their data collected. The end-points evaluated were the dichotomic data for mild (Grade 1) and moderate to severe (Grades 2 to 3) HSF. Meta-analysis was calculated through RevMan v5.1 software.


Amongst 195 potential articles, only six matched the inclusion criteria, with details described on the table below. In regards to mild HSF, the use of celecoxib presented statistical benefit (OR 0.35, 95% CI 0.22 to 0.58, p < 0.0001), while pyridoxine (OR 0.58, 95% CI 0.56 to 4.01) and topical urea/lactic acid (OR 1.6, 95% CI 0.5 to 5.16) failed to prove efficacy. The same pattern was observed for moderate to severe HSF, where celecoxib significantly reduced the number of events (OR 0.38, 95% CI 0.2 to 0.7, p = 0.002), unlike pyridoxine (OR 0.99, 95% CI 0.65 to 1.52) or topical urea/lactic acid (OR 1.55, 95% CI 0.69 to 3.45).

Author Year N Intervention Blinding
Köhne 2008 44 Celecoxib 800 mg Yes
Zhang 2012 139 Celecoxib 400 mg No
Zhang 2011 110 Celecoxib 400 mg No
von Gruenigen 2010 34 Pyridoxine 200 mg Yes
Kang 2010 389 Pyridoxine 200 mg Yes
Wolf 2010 137 Urea/lactic acid-based topic agent Yes


From all available possibilities for prevention of HSF, celecoxib appears to be the most promising agent, with statistically significant results. Larger, multicentric studies would be ideal to reinforce this hypothesis.


All authors have declared no conflicts of interest.