The common side effect of hand-foot syndrome seen in patients taking capecitabine can be prevented by a cheap and safe topical gel containing 1% diclofenac, researchers reported in a study that has been hailed by experts as 'practice changing.'
that"this might be the most practice changing study I heard at ASCO23." Topical diclofenac is"widely available, affordable, [and] addresses [a] major" quality of life issue.Pallavi Kumar, MD,
The takeaway is"that topical diclofenac significantly reduces the incidence of grade 2 or higher HFS in patients receiving capecitabine." The results are"very impressive," Kumar said.The idea for the new study came after Batra and his colleagues realized that celecoxib, a COX-2 enzyme inhibitor, helps prevent capecitabine hand-foot syndrome by blocking a key process that leads to it, the upregulation of COX-2 and subsequent release of pro-inflammatory prostaglandins.
To test the approach, the team randomly assigned 130 patients to topical diclofenac and 133 to placebo — the gel vehicle without the medication — while they were being treated with capecitabine for 12 weeks; 56% were being treated for breast cancer and the rest for gastrointestinal cancers. By the end of 12 weeks, the incidence of grade 2 or higher HFS was 3.8% in the diclofenac arm vs 15% with placebo , a 75% risk reduction.Hand-foot syndrome led to dose reductions of capecitabine in 13.5% of placebo but only 3.8% of those in the diclofenac group .
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