Prophylactic pyridoxine was not able to reduce the incidence of capecitabine-induced hand-foot syndrome: A meta-analysis

Hand-foot syndrome (HFS) is a dose-limiting adverse event of capecitabine, which commonly leads to early discontinuation of capecitabine-based therapy in the palliative and adjuvant settings. Although pyridoxine has been used for the prevention of capecitabine-associated HFS, its efficacy is controversial. The aim of this study was to evaluate whether prophylactic pyridoxine reduces the incidence of capecitabine-associated HFS by performing a meta-analysis of the literature involving available studies. Systematic searches for trials were undertaken through PubMed, Embase, Web of Science, the Cochrane Library, the American Society of Clinical Oncology (ASCO) and the ASCO Gastrointestinal Cancers Symposium, updated to March, 2013, to identify relevant studies. A meta-analysis was conducted with eligible studies that evaluated the efficacy of the prophylactic use of pyridoxine against capecitabine-induced HFS. We performed a meta-analysis of five studies (n=793 patients) that evaluated the efficacy of the prophylactic use of pyridoxine in cancer patients treated with capecitabine. The odds ratio (OR) comparing prophylactic pyridoxine to placebo was 0.91 [95% confidence interval (CI): 0.67-1.24] for HFS of all grades; OR=1.17 (95% CI: 0.82-1.67) for HFS ≥ grade 2 and OR=1.05 (95% CI: 0.60-1.85) for HFS ≥ grade 3. Based on our meta-analysis, prophylactic pyridoxine did not appear to reduce the incidence of HFS in patients receiving capecitabine.