Capecitabine Induced Hand-Foot Syndrome: A Systematic Review of Case Reports

Objective: Capecitabine, a prodrug of 5-fluorouracil, is currently used in the treatment of metastatic colorectal and breast cancers. The aim of this study was to review the pharmacological mechanisms, treatment strategies, and documented case reports of capecitabine-induced hand–foot syndrome (HFS).Methods: All case reports documented in the PubMed, Web of Science, and Scopus databases up to February 2018 were searched and reviewed using the keywords capecitabine, hand-foot syndrome, and case report.Results: The database search identified 373 articles in the literature; of these, 88 articles (having 111 case reports) in the English or Turkish language having a full-text access were included in the study. The median duration of capecitabine-induced HFS was 28 (range, 7–140) days, and the daily dose of capecitabine ranged between 850 and 5000 mg/m2 in cases wherein capecitabine was applied as monotherapy(n=19). A dose reduction or treatment discontinuation, systemic or topical treatment alone or in combination, and the use of henna, vitamin E, or pyridoxine were preferred options in the treatment of HFS.Conclusion: Health care providers and patients should be aware of developing capecitabine-induced HFS and its risk factors. Early recognition and treatment initiation for HFS are important to maintain effective chemotherapy in patients with cancer.