Incidence and implications of chemotherapy related hand-foot syndrome

ABSTRACT

Introduction: Hand-foot syndrome (HFS) is a well-established cutaneous adverse event of certain chemotherapeutic agents, mainly capecitabine, continuously infused 5-fluorouracil, docetaxel and pegylated liposomal doxorubicin. Erythema, dysesthesia, pain, cracking and desquamation located on palms and soles are the most characteristic manifestations. Although HFS is a reversible and non-life-threatening clinical condition, it can often affect patient’s quality of life significantly, hence necessitating therapeutic modifications or even treatment discontinuation.

Areas covered: This is review article on current data regarding the clinical characteristics, grading and management of HFS. Special focus has been given to recent literature studying novel therapeutic strategies.

Expert opinion: Early recognition, patient education and supportive measures are considered as the key elements in the management of HFS. Up to date, treatment interruption and dose intensity reduction are the mainstay of HFS management. Many topical formulations and systemic treatment regimens have been proposed, with COX-2 inhibitors being the most promising agents. Nevertheless, large prospective randomized controlled trials are needed in order to agree on solid, evidence-based treatment algorithms.

KEYWORDS:

• Hand-foot syndrome
• palmoplantar erythrodysesthesia
• chemotherapy
• capecitabine
• 5-fluorouracil

Article highlights

• HFS is a common side effect of anthracyclines (pegylated liposome-encapsulated doxorubicin) and pyrimidine analogues (5-FU and derivatives).

• HFS has a major impact on patient’s quality of life, necessitating dose reduction or treatment interruption.

• HFS requires regular assessment and supportive treatment strategies.

• Prospective randomized controlled trials examining the effectiveness of empirically used topical and systemic treatments are lacking. Effective pharmacologic intervention is an active area of research.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded