Novel & effective management of capecitabine induced Hand Foot Syndrome

Abstract

8105 Background: Hand foot syndrome ( Palmar plantar erythrodysesthesia ) is common side effect of capecitabine. Grade II-III toxicity is seen in 10–50%of the patients and may lead to discomfort with activities of daily living. Interruption in the treatment and dose reductions are very frequent due to this toxicity. Aim of the study was to analyze efficacy of local application of keratolytic agent - urea (12.5%) (Cotoryl R) on capecitabine induced toxicity. Methods: Patients on capecitabine were followed for signs of hand foot syndrome. Thirteen such episodes were recorded. Out of theses 4 episodes were of grade III and 9 of grade II toxicity. All had dry furrowed skin, rash, desquamation on the palms of the hands and soles of the feet. Patients with grade III toxicity had additionally painful erythema, discomfort with activities of daily living. All patients were asked to apply locally, twice a day, urea containing moisturizing ointment. The same preparation was used prophylactically in 7 cycles of capecitabine. Results: This application had a dramatic impact on dermatological complications within 2–3 days of initiation. The effect lasted till continuation of the application. It lead to reduction in desquamation, pain, and comfort level of all the patients improved. Neurological symptoms improved as well. All patients were able to complete the chemotherapy cycle as per the schedule and without interruption or delays. Efficacy was seen in patients where it was used prophylactically. 5/7 did not develop cutaneous manifestation and two had grade I toxicity. Conclusions: Urea containing preparation appears to be an excellent choice for the prevention and treatment of capecitabine induced hand foot syndrome. This minimizes drug delays, schedule interruptions and maintains the dose density. Owing to reduced morbidity, the drug tolerance and acceptance is considerably improved. No significant financial relationships to disclose.