Herbal medicine for hand–foot syndrome induced by fluoropyrimidines: A systematic review and meta‐analysis

Abstract

The aims of this study were to evaluate the efficacy of herbal medicine for the prevention and management of hand-foot syndrome (HFS) induced by fluoropyrimidines and to identify herbs associated with HFS alleviation for further research. The PubMed, Cochrane, Springer, China National Knowledge Infrastructure, and Wanfang databases were searched up to May 2017 for randomized controlled trials (RCTs) that evaluated herbal medicine for relieving HFS in patients undergoing fluoropyrimidine-based chemotherapy. Study evaluation and synthesis methods were in accordance with the Cochrane Handbook, and data were analyzed using RevMan 5.3. In total, 35 RCTs (2,668 participants) were included. Meta-analysis showed that the addition of herbal medicine significantly reduced the incidences of all-grade and high-grade HFS. The total effective rate and complete remission rate of HFS patients increased significantly with herbal medicine arm. Further sensitivity analysis identified Paeoniae Radix Alba, Carthami Flos, Cinnamomi Ramulus, and Glycyrrhizae Radix et Rhizoma as being consistently associated with significant reductions in HFS incidence without important heterogeneity. However, the lack of blinding in most studies may have led to overestimation of these effects. More high-quality RCTs and experimental research are needed to confirm and investigate the efficacy of the herbs identified in this study.

How to conduct integrated pharmaceutical care for patients with hand-foot syndrome associated with chemotherapeutic agents and targeted drugs

“…And the importance of maintaining original dose should also be reinforced throughout the whole treatment if HFS is tolerable. When the HFS does appear, some evidence-based managements could try according to patient's therapy regimen and the medicine's accessibility, such as celecoxib, 59 regional cooling, 28,62 antiperspirant, 63 pyridoxine (400 mg) 69,70 and herbs, 74 although the current data is yet insufficient to illustrate its effect on shortening the sustaining duration or relieving the symptom of HFS. However, dose reduction or disruption, according to Table 4, should be considered if intolerable HFS happens.…”

“…Another more widely meta-analysis involved 35 RCTs evaluated the efficacy of herbal medicine for the prevention and management of HFS induced by 5-Fu. 74 Results showed that the addition of herbal medicine significantly reduced the incidences of all-grade and high-grade HFS. Further sensitivity analysis even identified four herbs (Paeoniae Radix Alba, Carthami Flos, Cinnamomi Ramulus, and Glycyrrhizae Radix et Rhizoma) as being consistently associated with significant reductions in HFS incidence without important heterogeneity.…”

Effect of Chinese Herbal Compound LC09 on Patients With Capecitabine-Associated Hand-Foot Syndrome: A Randomized, Double-Blind, and Parallel-Controlled Trial

“…Effect was defined as NCI grade decreasing by at least one grade. In earlier studies, the HFS effectiveness rate in the herbal group was about 80% to 90%, [20][21][22] and in our earlier study, LC09's pain alleviation rate was 88.06%. 15 Because in this trial LC09 is made into granules, and granules may influence dissolution rate, we estimated an effective rate of 80% in the treatment group.…”

Predictors of oral chemotherapy adherence at home among Chinese cancer patients: An observational prospective study

“…Numbness/tingling is one typical hand–foot syndrome symptom of these medications (Cassidy et al, 2002; Ter Veer et al, 2016). Although hand–foot syndrome is reversible (Deng & Sun, 2018), it decreased patients’ quality of life (Urakawa et al, 2019) and lowered patients’ willingness to continue the treatment (Komatsu et al, 2019). Until now, no effective treatment methods existed for hand–foot syndrome besides dose reduction or treatment deferral (Nikolaou et al, 2016).…”