
Oral Capecitabine - Can It Cause The
Hand-Foot Syndrome?
376-378
Correspondence
AKASH S S, Dept. of Pharmacology, Goa Medical College,
Panaji, Goa, India
EMAIL - drsurendraakash@yahoo.com,
suryadear@yahoo.com
The Hand Foot Syndrome (HFS) or palmo-plantar erythrodysesthaesia (PPE) manifests as acral erythema with swelling and dysesthaesia of the palms and the plantar aspects of the feet, which in the absence of dosage reduction or drug cessation, progresses to moist desquamation and ulceration, resulting in serious infections and loss of function (1).
The Hand –foot syndrome is a cutaneous adverse event which is associated with various anti- cancerous chemotherapeutic drugs viz; capecitabine, 5-fluorouracil, cytarabine, doxorubicin, epirubicin, fluorodeoxyuridine(FUDR), mercaptopurine, cyclophosphamide, docetaxel, (2) gemcitabine, sunitinib, erlotinib and sorafenib (3), idarubicin (4), vinorelbine (1), high doseinterleukin(IL2) (5) , hydroxyurea (6), mitotane, and thiotepa. Although the pathogenesis of HFS is not fully understood, it is suspected that it may be caused due to damaged deep capillaries in the soles of the feet and on the palms of the hands, leading to a COX inflammatory-type reaction, or that it is related to the enzymes which are involved in the metabolism of capecitabine, namely, thymidine phosphorylase and dihydropyrimidine dehydrogenase. Ethnic variations in the clinical manifestation of HFS warrant further attention, and an alternative system for grading HFS in non-white patients has been proposed (7).
We report here, a case of HFS, induced by oral capecitabine, with moist desquamation and ulceration over the feet and hands.