APPENDICURE

The clinical trial was featured in Journal of Clinical Oncology – ASCO Publications

Can a Topical Gel Help Prevent Hand-Foot Syndrome from Capecitabine? What Research Shows…

This morning I was talking with a friend. Her husband is experiencing a recurrence. She heard topical gels like Voltaren® can help with symptoms or even prevent hand-foot syndrome. His first day of chemo was yesterday and he immediately started slabbing it all over his hands and feet. I’ll keep you posted on how it goes.

I immediately started searching and found out that a trial was done back in 2024.

Many patients treated with capecitabine — an oral chemotherapy drug used commonly in breast and gastrointestinal cancers — develop a painful side effect called hand-foot syndrome (HFS). This condition can cause redness, swelling, and tenderness on the palms of the hands and soles of the feet. In some cases, it becomes severe enough that doctors must reduce or delay chemotherapy doses, which can affect treatment effectiveness.

This clinical trial looked at whether applying a topical gel like Voltaren® could reduce the risk of this side effect. The results suggest a simple preventive option may be feasible.

The Purpose of the Trial

The study tested whether topical diclofenac gel — an anti-inflammatory medication applied to the hands — could prevent hand-foot syndrome in patients with cancer who were taking capecitabine. Diclofenac works locally to block inflammatory pathways that are believed to contribute to HFS. Because it acts on the skin and not throughout the body, it has a lower risk of the systemic side effects seen with oral anti-inflammatories.

The Design of the Trial

• Participants: 264 adult patients with breast or gastrointestinal cancers scheduled to start capecitabine.
• Randomization: Patients were randomly assigned to apply either topical diclofenac gel or a placebo gel (a similar gel without the drug).
• Application: Gel was applied to hands twice daily for up to 12 weeks or until HFS developed.
• Primary Measure: The main outcome was the rate of moderate to severe HFS (grade 2 or 3) during the study.

Key Findings Patients Should Know

Significant Reduction in Moderate/Severe HFS:
Only 3.8% of participants using diclofenac developed grade 2 or 3 hand-foot syndrome, compared with 15.0% in the placebo group. This is a meaningful absolute reduction in risk.

Overall HFS Lower in the Treatment Group:
When considering all grades of hand-foot syndrome (mild to severe), the diclofenac group had fewer cases than the placebo group (6.1% vs 18.1%).

Fewer Chemotherapy Dose Reductions:
Patients using the diclofenac gel were less likely to need a capecitabine dose reduction due to HFS (3.8%) compared to the placebo group (13.5%). Maintaining planned chemotherapy dosing is important for treatment effectiveness.

Takeaways for Patients and Caregivers

This trial supports the idea that a topical anti-inflammatory gel applied to the hands may help prevent hand-foot syndrome in patients receiving capecitabine. Because HFS can cause discomfort and interfere with chemotherapy schedules, preventing it has real value for quality of life and treatment continuity.

Daily skin care is already recommended for patients on capecitabine. This study suggests that adding a targeted topical anti-inflammatory may further reduce the risk of significant symptoms — though this approach should always be discussed with your oncology team before starting, to ensure it aligns with your overall care plan.

Practical Notes for Consideration

Diclofenac gel is available by prescription and over the counter in the US and Europe. It is used for localized pain/inflammation often associated with arthritis. Its safety profile when used in this preventive way appears favorable, but your doctor should evaluate whether it’s appropriate for you.

Skin monitoring remains important. Early changes in the hands and feet should be reported promptly to your care team, whether or not you are using preventive gel.

More research may follow. Larger studies or guideline updates could further clarify how this approach fits into standard care. This summary is intended to inform patients and caregivers about recent research related to capecitabine-associated hand-foot syndrome and does not replace medical advice from your healthcare provider.