Hemoglobin Value Is the Most Important Factor in the Development of Hand-Foot Syndrome under the Capecitabine Regimen

Abstract

Background: Hand-foot syndrome (HFS) is a common side effect that has a high occurrence rate with capecitabine (Cape) chemotherapy. However, little is known about the risk factors of developing HFS under the Cape regimen. Our aim was to examine these risk factors. Methods: A univariate analysis was used to determine the risk factors associated with developing HFS, and we calculated the effect sizes between the patients who developed HFS compared to those who did not. Results: Of the 52 patients enrolled in our research, 24 (46.2%) developed HFS. This group was significantly associated with hemoglobin (Hb) values (p < 0.001), and the effect size (1.21) was more than moderate. The receiver operating characteristic curve analysis confirmed 12 mg/dl Hb as the best diagnostic cut-off value for developing HFS. The sensitivity and specificity were 75.5 and 88.2%, respectively. Patients who had Hb values of 12 or below who developed HFS had longer median times without HFS compared to patients with high Hb values (115 vs. 75 days, p = 0.30, hazard ratio = 1.42, 95% CI 0.73-2.76) and a greater area under the Kaplan-Meier curves (p < 0.05). Conclusion: This research suggests that the Hb value is an important factor for developing HFS.

Clinical evidence of prevention strategies for capecitabine‐induced hand‐foot syndrome

“…A total of 2081 patients (mean sample size: 122; median sample size with corresponding range: 106 ) were included in this meta-analysis. 11,27 The following prevention strategies were addressed in the analyzed studies: pyridoxine (10 studies) 8,11,12,[19][20][21][22]24,26,27 ; topical urea/ lactic acid (three studies) 8,10,25 ; celecoxib (two studies) 9,28 ; and moisturizing cream, topical silymarin, Fuzheng Jiedusan and neurotropin (four studies). 8,17,19,27,28 Fifteen studies only assessed the prophylactic efficacies of prevention strategies, [8][9][10][11][12][17][18][19][20][21][22][23][24][25][26][27][28] and two studies assessed prophylactic and treatment efficacies.…”

“…Of the eligible studies, 12 were RCTs, [9][10][11][12]18,[20][21][22][23][24][25][26] and five were cohort studies. [17][18][19]23 The main characteristics of the included studies are shown in Table 1. 11,27 The following prevention strategies were addressed in the analyzed studies: pyridoxine (10 studies) 8,11,12,[19][20][21][22]24,26,27 ; topical urea/ lactic acid (three studies) 8,10,25 ; celecoxib (two studies) 9,28 ; and moisturizing cream, topical silymarin, Fuzheng Jiedusan and neurotropin (four studies).…”

“…[17][18][19]23 Elyasi et al reported that the prophylactic use of topical silymarin significantly reduced severe capecitabine-induced HFS. [17][18][19]23 Elyasi et al reported that the prophylactic use of topical silymarin significantly reduced severe capecitabine-induced HFS.…”

“…18 Zhou et al indicated that the herbal medicine of Fuzheng Jiedusan decreased the incidence of capecitabine-induced HFS (RR 5 0.50, 95% CI 5 0.30-0.84). 19,23 Treatment efficacy of pyridoxine Two studies evaluated the treatment efficacy of pyridoxine in patients who developed capecitabine-induced HFS during chemotherapy. 19,23 Treatment efficacy of pyridoxine Two studies evaluated the treatment efficacy of pyridoxine in patients who developed capecitabine-induced HFS during chemotherapy.…”

“…A total of 17 studies were included in this meta-analysis (Figure 1). [8][9][10][11][12][17][18][19][20][21][22][23][24][25][26][27][28] These studies were published from 2002 to 2017 in the United States, Germany, United Kingdom, Singapore, China,…”