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Diclofenac Gel shown to help prevent Hand-Foot Syndrome

New research shows that a diclofenac gel applied to the skin reduced rates of Hand-Foot Syndrome by 75% in people taking Xeloda, otherwise known as Capecitabine, for breast and gastrointestinal cancer.


Research presented on 3 June 2023, at the American Society of Clinical Oncology (ASCO) Annual Meeting shows that topical diclofenac is effective in preventing all grades of Hand-Foot Syndrome in patients receiving capecitabine. Diclofenac application was also associated with lesser dose reductions of capecitabine. This trial establishes topical diclofenac as the new standard of care to prevent capecitabine associated Hand-Foot Syndrome.

About hand-foot syndrome

Also called palmar-plantar erythrodysesthesia (PPE), Hand-Foot Syndrome is a side effect of some types of chemotherapy and targeted therapy medicines used to treat breast cancer. It is a known common side effect of Xeloda.

Hand-Foot Syndrome is a skin reaction that happens when a small amount of medicine leaks out of the small blood vessels called capillaries, usually on the palms of the hands and the soles of the feet, and damages the surrounding tissue.

Symptoms of Hand-Foot Syndrome include:

  • numbness

  • tingling, burning, or itching

  • redness and swelling

  • discomfort and tenderness

  • rash

It’s more severe symptoms are:

  • blisters or sores on the palms of the hands and soles of the feet

  • intense pain

  • difficulty walking or using your hands

Hand-Foot Syndrome can dramatically decrease a person’s quality of life. Currently, there is only one treatment that helps prevent it: Celebrex, otherwise know as celecoxib, a nonsteroidal anti-inflammatory drug (NSAID). However, because of Celebrex’s side effects — increased risk of heart attack, stroke, and ulcers — it isn’t widely used to treat or prevent hand-foot syndrome, meaning that people who develop hand-foot syndrome while taking Xeloda often have to reduce the dose of the medicine or stop taking it altogether.  

About Diclofenac Gel

Diclofenac gel, sold as a generic or under the brand name Voltaren, is a topical NSAID (nonsteroidal anti-inflammatory drug) gel commonly used to treat osteoarthritis. Depending on the size of the tube, it costs between £5 and £20 and is available at a wide variety of stores and online.

Because diclofenac gel is also an NSAID, it can still increase the risk of heart attack and ulcers, but because a smaller amount is used and is applied topically, the risk is lower.  

About the Research

Called D-TORCH, the small study conducted in India included 263 people diagnosed with breast or gastrointestinal cancer. All the people were scheduled to take Xeloda, either alone or in combination with other medicines.

The researchers split the people into two treatment groups:

  • 130 people applied a fingertip amount of diclofenac gel to the palms of their hands and soles of their feet twice a day for 12 weeks — four cycles of Xeloda — or until they developed Hand-Foot Syndrome

  • 133 people applied the same amount of a placebo, a gel that looked just like the diclofenac gel, but contained no medicine, for the same amount of time

Rates of grade 2 or more severe Hand-Foot Syndrome were:

  • 3.8% in people using the diclofenac gel

  • 15% in people using the placebo gel

This difference was statistically significant, which means that it was likely due to the difference in treatment and not just because of chance.

Rates of any grade of Hand-Foot Syndrome also were lower in people using diclofenac gel:

  • 6.1% of people using the diclofenac gel had any grade of Hand-Foot Syndrome

  • 18.1% of people using the placebo gel had any grade of Hand-Foot Syndrome

This difference was also statistically significant.

People using the diclofenac gel also were less likely to have to reduce their dose of Xeloda than people using the placebo gel.

Using the gel didn’t seem to cause any side effects.

“[This trial] establishes 1% topical diclofenac gel as the new standard of care to prevent capecitabine-associated Hand-Foot Syndrome,” said Atul Batra, MD, a medical oncologist at the All India Institute of Medical Sciences, who presented the research.

establishes 1% topical diclofenac gel as the new standard of care to prevent capecitabine-associated Hand-Foot Syndrome

Dr. Batra also said that his clinic now routinely uses diclofenac gel during capecitabine treatment and that he hopes other oncology practices do the same.

Tarah Ballinger, MD, assistant professor of medicine and medical director of the Breast Cancer Prevention Program at Indiana University, tweeted, “This might be the most practice changing study I heard at the conference.” Topical diclofenac is “widely available, affordable, [and] addresses major quality of life issue and dose delivery issue[s].”  

What this means for you

If you’re scheduled to take Xeloda, these results are wonderful news. Diclofenac gel is inexpensive, widely available, and doesn’t cause any additional side effects. So it makes sense to talk to your oncologist about using a small amount twice a day for 12 weeks while you’re taking Xeloda to help reduce the risk of Hand-Foot Syndrome.


CancerPal doesn't currently sell any diclofenac gels, but they are widely available in retail stores and can be found on Amazon here. We also sell a selection of other items that have been recommended to help prevent and manage the side effects of Hand-Foot Syndrome in the Hand-Foot Syndrome section of the CancerPal MarketPlace.


The information in this article is provided by Donate to support free resources and programming for people affected by breast cancer.


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