Managing Chemo-Related Hand-Foot Syndrome

Understanding the impact of side effects from drugs such as Xeloda (capecitabine) is important, especially when taking preventive measures seriously, an expert told CURE®.

Specifically, Xeloda may lead to hand-foot syndrome in patients with breast gastrointestinal cancers, according to a study recently published in the Journal of Clinical Oncology.

Xeloda is a type of oral chemotherapy, known as a type of antimetabolite. It is “taken up by cancer cells and breaks down into fluorouracil,” which is a substance that kills cancer cells, the National Cancer Institute defines.

Hand-foot syndrome is a side effect caused by certain chemotherapy drugs that may cause redness, swelling and blistering on the palm of hands and the soles of feet, The University of Texas MD Anderson Cancer Center states.

Hand-Foot Syndrome Caused by Xeloda

“There’s always collateral damage for any drug,” Dr. Namrata “Neena” Vijayvergia of Fox Chase Cancer Center in Philadelphia, explained to CURE®. “One [type of] collateral damage it can do is in the hands and feet. It can make the skin of the hands and feet very dry and become thick, or ‘keratotic,’ as we call it.”

Vijayvergia is the assistant chief of gastrointestinal medical oncology and medical director of medical oncology at Fox Chase Cancer Center.

She added that hand-foot syndrome causes the skin to peel off, which can be “unsightly” and painful for patients.

“[It’s painful enough] that patients cannot open bottles or use their hands and feet as easily, or [being] comfortably walking,” Vijayvergia said.

She noted that there are different grades of side effects, which also impact patients’ quality of life; lower-grade side effects mean they are less disturbing for patients.

“Grade 1 hand-foot syndrome is a little bit of a dent in quality of life, appearance and it may feel a little warm,” Vijayvergia explained. She also added that patients who experience grade 1 side effects may not have to take any additional medications for pain.

She emphasized that monitoring hand-foot syndrome while it’s grade 1 or 2 is important. Otherwise, it can worsen and become grade 3 or 4, which can significantly affect patients’ quality of life.

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Ways to Manage and Mitigate Side Effects

“The only way to treat [hand-foot syndrome] is to hold [Xeloda],” Vijayvergia explained. 'Holding' a drug is when patients either receive a lower dose or stop the treatment until hand-foot syndrome fully heals. Then, the patient recovers before slowly increasing the dose again.

“We want to do everything we can to make sure we are able to deliver the maximum dose and the maximum recommended therapeutic dosing and frequency of the drug,” Vijayvergia said. “If there’s anything we can do to prevent side effects that require [dose] reductions, [then we] treat patients at appropriate dosing to the best of our abilities.”

She noted that although “moisturizing is key,” for patients receiving Xeloda, hand-foot syndrome typically does not go away without a reducing the dose of the drug.

However, Vijayvergia advised that patients with breast cancer or gastrointestinal cancers taking Xeloda should be proactive about prevention if they have not developed hand-foot syndrome caused by the drug.

“Moisturizing is key,” Vijayvergia said, “Urea-based creams are what are preferred for [hand-foot syndrome]. There are different kinds of really good products out there. I tell my patients to use it every day — morning and night — but especially at nighttime. [I tell them to] lather it on their hands and feet and wear cotton gloves and cotton socks to sleep so that the moisture remains.”

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