Abstract 1579P
Background
Hand-foot syndrome (HFS) and Hand Foot Skin Reaction (HFSR) are common toxicities of several systemic cancer treatments. Multikinase inhibitor- induced HFSR is distinguished from chemotherapy-induced HFS in terms of pathogenesis, symptomatology, and treatment. Multiple trials have investigated the efficacy of preventive strategies such as COX-inhibitors, pyridoxine and urea cream, however, no consensus has been made. This meta-analysis evaluated data from high quality trials to provide strong evidence in forming recommendations to prevent systemic cancer therapy-induced HFS/HFSR.
Methods
A systematic search of Pubmed, Embase, Cochrane, clinical trials databases and hand searching were utilized to identify randomized trials (RCTs) investigating prophylactic strategies for HFS/HFSR in cancer patients receiving systemic treatment. Trials published until August 2021 were included. Using the random effects model, pooled odds ratios were calculated for rates of all-grade and severe HFS/HFSR. Subgroup analysis based on type of cancer treatment given was done.
Results
Sixteen RCTs were included (N=2814). For all-grade HFS/HFSR, celecoxib (OR 0.52,95%CI 0.32-0.85, p=0.009) and urea cream (OR 0.48,95%CI 0.39-0.60, p<0.00001) both showed statistically significant risk reduction. Celecoxib was effective in preventing HFS in patients who received capecitabine (50.5% vs 65%, p=0.05), while urea cream was effective in both capecitabine HFS (22.3% vs 39.5%,p=0.02) and sorafenib-induced HFSR (54.9% vs 71.4%,p<0.00001). Pyridoxine at higher doses showed a trend towards benefit in preventing all grade HFS (69.6% vs 74.1%, p=0.23).
Conclusions
Urea cream and celecoxib are effective in preventing all-grade and moderate to severe grade HFS/HFSR in patients receiving systemic cancer treatment. Our study provides evidence that celecoxib can be more effective for capecitabine-induced HFS and urea cream for sorafenib-induced HFSR. Studies investigating optimal dosing for celecoxib and urea cream are recommended. There is inadequate evidence to make recommendations regarding pyridoxine.
Clinical trial identification
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.