In this systematic review and network meta-analysis, diclofenac and silymarin were the most effective preventive strategies for hand-foot syndrome in patients with cancer, with silymarin requiring confirmation in a larger randomized trial.
Diclofenac emerged as the agent with the best overall supporting evidence, informed by both effect estimates and study quality.
Question Which of the prophylactic agents for treating chemotherapy-induced hand-foot syndrome (HFS) is the most effective for preventing clinically significant HFS in patients with cancer?
Findings In this systematic review and network meta-analysis of 17 randomized clinical trials including 2,192 patients, topical diclofenac, silymarin, 400-mg pyridoxine, and celecoxib significantly reduced the incidence of grade 2 or higher HFS compared with placebo; diclofenac and celecoxib were also effective in reducing overall HFS incidence.
Meaning These findings indicate that diclofenac is the prophylactic agent with the best supporting evidence for prevention of HFS in patients with cancer.