Authors:
Joanne E. Mortimer, MD
Mary Kay Lauman, RN
Benjamin Tan, MD
Cindy L. Dempsey, PharmD
Alicia C. Shillington, RN, MPH, PhD
Kellie S. Hutchins, PharmD

Abstract:

We conducted our study to determine incidence and severity of Hand-and-Foot Syndrome (HFS) symptoms in patients treated with capecitabine and to assess effects of pyridoxine administered as prophylaxis or treatment. A retrospective review chart review was conducted on 99 charts of capecitabine patients receiving pyridoxine and 99 charts of those who had not. Of the 99 pyridoxine patients, 73 (74%) received it as prophylaxis with the remainder receiving pyridoxine as acute HFS treatment. The median number of capecitabine cycles was 5 with first reported HFS onset at cycle 2 in those receiving pyridoxine prophylaxis versus 1.5 in those not (p = 0.06). Incidence was significantly associated with capecitabine dose with 76% of patients experiencing HFS in the highest dose ranges compared to 40% in the lowest (p < 0.01). Our data did not support that pyridoxine prophylaxis prevented overall HFS incidence in a greater proportion of patients compared to those who did not receive prophylaxis (60% versus 53%, respectively, p = NS). However, when used as treatment, a greater proportion of patients receiving pyridoxine reported symptom improvement compared to those not receiving the agent (65% versus 12%, p < 0.001). No differences in twelve-week tumor response were seen. Although limited by its retrospective design, we conclude that further study of pyridoxine’s value in HFS prevention/treatment is warranted.