A phase II study evaluating the preventive effect of topical hydrocortisone for capecitabine-induced hand-foot syndrome in patients with colorectal cancer receiving adjuvant chemotherapy with capecitabine plus oxaliplatin (T-CRACC study)

Background Topical steroids may help prevent capecitabine-induced hand-foot syndrome in patients with colorectal cancer, as inflammation is involved in anti-tumor agent-induced hand-foot syndrome development. We assessed the preventive efficacy of medium-class topical corticosteroids for capecitabine-induced hand-foot syndrome in patients receiving adjuvant chemotherapy for colorectal cancer. Methods This open-label, single-arm, single-center phase II study included patients with colorectal cancer receiving adjuvant chemotherapy with capecitabine + oxaliplatin in a 3-week cycle. Prophylactic topical hydrocortisone butyrate (0.1%) was applied to the palms and soles from day 1 of adjuvant chemotherapy. The primary endpoint was grade ≥ 2 hand-foot syndrome incidence within four cycles. Secondary endpoints were the time to onset and incidence of each hand-foot syndrome grade, dose reduction, schedule delay, hand-foot syndrome-induced discontinuation, and other adverse events. Results Fifty patients were enrolled; three were excluded. Among the 47 included (median age = 54.5 years), 100% had Eastern Cooperative Oncology Group performance status 0, 40% were male, and 94% had pathological stage III disease. Dose reduction, schedule delay, and hand-foot syndrome-induced discontinuation were required in 0, 2, and 0 patients, respectively, with a median relative capecitabine dose intensity of 100% within four cycles. Grade ≥ 2 hand-foot syndrome incidence during the cycles was 6.4%. Time to onset of grades ≥ 1 and ≥ 2 was 63.5 and 105.5 days, respectively. One patient experienced grade 3 hand-foot syndrome on day 164. The most common grade ≥ 2 adverse events were peripheral sensory neuropathy and neutropenia. No topical hydrocortisone butyrate (0.1%)-induced adverse events occurred. Conclusions Topical hydrocortisone butyrate (0.1%) may prevent capecitabine-induced hand-foot syndrome. Trial registration number and date of registration: This clinical trial is registered in the Japan Registry of Clinical Trials (jRCT) as jRCTs031220002).