Coming to grips with hand-foot syndrome. Insights from clinical trials evaluating capecitabine.

Hand-foot syndrome is a localized cutaneous side effect associated with the administration of several chemotherapeutic agents, including the oralfluoropyrimidine capecitabine (Xeloda). It is never life-threatening but can develop into a painful and debilitating condition that interferes with patients' normal daily activities and quality of life. Several symptomatic/prophylactic treatments have been used to alleviate hand-foot syndrome, but as yet there is insufficient prospective clinical evidence to support their use. The only proven method of managing hand-foot syndrome is treatment modification (interruption and/or dose reduction), and this strategy is recommended for patients receiving capecitabine. Retrospective analysis of safety data from two large phase III trials investigating capecitabine as first-line therapy in patients with colorectal cancer confirms that this strategy is effective in the management of hand-foot syndrome and does not impair the efficacy of capecitabine. This finding is supported by studies evaluating capecitabine in metastatic breast cancer. Notably, the incidence and management of hand-foot syndrome are similar when capecitabine is administered in the metastatic and adjuvant settings, as monotherapy, or in combination with docetaxel (Taxotere). It is important that patients learn to recognize the symptoms of hand-foot syndrome, so that prompt symptomatic treatment and treatment modification strategies can be implemented.