Key result
Prophylactic topical diclofenac allowed 90.4% of patients on capecitabine to complete 12 weeks of chemotherapy without developing clinically significant (Grade ≥2) hand-foot syndrome.
Why the study?
Capecitabine is frequently associated with dose-limiting hand-foot syndrome, and this study evaluated topical diclofenac for preventing hand-foot syndrome in routine clinical practice following findings from the D-TORCH trial.
Does topical diclofenac prevent capecitabine-induced hand-foot syndrome in patients with cancer?
Cohort (n=52)
No
Does topical diclofenac prevent capecitabine-induced hand-foot syndrome in patients with cancer?
Topical diclofenac is an effective and affordable real-world option for preventing capecitabine-induced hand-foot syndrome.
Should not yet change practice; extends D-TORCH to real-world settings but leaves open controlled confirmation.
A BSTRACT Background: Capecitabine is widely used in the treatment of various solid tumors but is frequently associated with hand–foot syndrome (HFS), a common and often dose-limiting dermatologic toxicity. The D-TORCH trial recently demonstrated that topical diclofenac significantly reduces the incidence of capecitabine-induced HFS. This study evaluates topical diclofenac for preventing HFS in patients on capecitabine. Materials and Methods: We conducted a retrospective, single-arm, cohort study at a medical college in West Bengal between April 2024 and January 2025. Fifty-two patients with gastrointestinal, hepato-pancreatic-biliary, breast, or skin cancers receiving capecitabine-based regimens and compliant with prophylactic topical diclofenac therapy were included. Patients applied 1% diclofenac gel to their hands twice daily for 12 weeks or until the development of Grade ≥2 HFS. HFS grading was assessed at each chemotherapy cycle per standard clinical protocols. Results: Among 52 eligible patients, 47 (90.4%) completed 12 weeks of chemotherapy without developing clinically significant (Grade ≥2) HFS. Five patients developed Grade ≥2 HFS, all on triplet chemotherapy. One patient (1.9%) developed Grade 3 HFS, which was managed with dose modification. Among 47 patients, mild HFS (Grade 1) was observed in 22 patients (46.8%), while 17 (36.1%) did not develop any HFS. HFS was less frequent and severe with capecitabine monotherapy or doublets than with triplets. Conclusion: Topical diclofenac is a safe, effective, and affordable option for preventing capecitabine-induced HFS, particularly with monotherapy or doublet regimens, supporting its use in routine practice and resource-limited settings.
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Biswas et al. (2026) conducted a cohort in Capecitabine-induced hand-foot syndrome (n=52). Topical diclofenac was evaluated on Completion of 12 weeks of chemotherapy without developing clinically significant (Grade ≥2) HFS. Prophylactic topical diclofenac allowed 90.4% of patients on capecitabine to complete 12 weeks of chemotherapy without developing clinically significant (Grade ≥2) hand-foot syndrome.
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