Prevention strategies for chemotherapy-induced hand-foot syndrome: a systematic review and meta-analysis of prospective randomised trials.
OBJECTIVE
Hand-foot syndrome (HSF) is a distinctive adverse event relatively frequent to some chemotherapeutic agents as capecitabine, pegylated liposomal doxorubicin, sorafenib and other tyrosine-kinase inhibitors. Since the prevention of HFS would be crucial to avoid treatment interruptions and delays, many studies have been conducted with this purpose.


METHODS
The aim of this systematic review and meta-analysis was to analyze the clinical efficacy of prevention strategies for HFS, through a wide search of electronic databases as well as congress abstracts. The endpoints evaluated were the dichotomic data for mild (Grade 1), moderate to severe (Grades 2 to 3) and all-grade HFS. Meta-analysis was calculated through RevMan v5.1 software.


RESULTS
Amongst 295 studies identified, only ten met the inclusion criteria. Celecoxib prevented both moderate to severe (odds ratio [OR] 0.39, 95 % confidence interval [CI] 0.20-0.73, P = 0.003) and all-grade HFS (OR 0.47, 95 % CI 0.29-0.78, P = 0.003), whereas pyridoxine and topical urea/lactic acid formulations failed to prove efficacy. There were no proven benefits in mild HFS. The use of topical antiperspirant has not been shown to improve results, according to a single trial.


CONCLUSIONS
From all available possibilities for the prevention of HFS, celecoxib appears to be the most promising, with statistically significant results. Larger, multicentric studies are required to reinforce this finding.
Clinical Oncology Division, General Hospital, State University of Campinas (UNICAMP), Vital Brasil, 251 - Cidade Universitária, 13083000, Campinas, Brazil, ligiamed@gmail.com.
Lígia Traldi
LT
Macedo
Joao Paulo Nogueira
JP
Lima
Lucas Vieira
LV
dos Santos
Andre Deeke
AD
Sasse
D000970:Antineoplastic Agents / Q000009:adverse effects*; D060831:Hand-Foot Syndrome / Q000517:prevention & control*; D006801:Humans; D016032:Randomized Controlled Trials as Topic
D000970:Antineoplastic Agents