436P - Chemotherapy-induced hand-foot syndrome, comparative efficacy and safety of pharmacological prophylaxis: Systematic review and network meta-analysis

Background

Hand-foot syndrome (HFS) is one of the most common toxicities experienced by patients receiving systemic chemotherapy agents such as capecitabine and multi-kinase inhibitors such as sorafenib. Several randomized controlled trials (RCT) have investigated the efficacy and safety of prophylactic agents such as pyridoxine, celecoxib, urea cream, and cystine/theanine in managing HFS. This network meta-analysis evaluated data from high-quality trials to provide strong evidence in forming recommendations to prevent systemic cancer therapy-induced HFS. Our objective is to examine the comparative efficacy and safety of interventions for preventing systemic chemotherapy-induced hand-foot syndrome (HFS) in cancer patients.

Methods

We searched PubMed, Embase, and clinical trial registry for RCTs of interventions for preventing HFS. Bayesian network meta-analysis (NMA) was performed to estimate the odds ratio (OR) with 95% credible intervals (CrI) from both direct and indirect evidence. The outcome measures were the incidence of HFS (grade ≥1) and moderate to severe HFS (grade ≥2). Adverse drug reactions were discussed descriptively.

Results

A total of 15 RCTs with 2715 patients with 12 prophylactic strategies were included. The analysis showed only celecoxib could significantly prevent the incidence of moderate to severe HFS (grade ≥ 2) (OR 0.29, 95% CrI 0.13 to 0.68). But none of the preventive interventions could prevent the incidence of HFS (grade ≥ 1).

Conclusions

Only celecoxib (200 mg BD) showed significant prevention of the incidence of moderate to severe HFS. Pyridoxine (400 mg OD) and urea cream (10%) have to be evaluated further in larger randomized trials.

Clinical trial identification

PROSPERO-CRD42022345583.

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.