Treatment of capecitabine-induced hand-foot syndrome using Chinese herbal lotion: A case report
Yang hongli ,MD
(Department of TCM Oncology, Cancer Hospital, Chinese Academy of Medical Sciences , Chaoyang District, Beijing 100021, China )
Abstract
Capecitabine is a widely used oral drug in clinical practice. After the treatment, about 50% of patients will appear the symptoms of hand-foot syndrome (HFS). These symptoms seriously affect the quality of life of patients and the clinical applications of the drug. Clinical practice has proved that Chinese herbal lotion can obviously improve the symptoms of HFS caused by capecitabine, improve the patients' quality of life. It is a simple worth promoting treatment.
Keywords Chinese herbal lotion, hand-foot syndrome, capecitabine
Introduction
Capecitabine is a new generation of oral fluorouracil chemotherapeutic drug. In the body, it can convert into a metabolic product of 5 – FU (Fluorine pyrimidine carbonate deoxyuridine drug). It can be selectively into the tumor cells and has the advantages of high efficiency, convenience, less adverse reaction. So it is easily accepted by patients. Capecitabine can inhibit cell division and interference RNA and protein synthesis. Be Suitable for the treatments of breast cancer, rectal cancer, colon cancer and gastric cancer. But almost half of patients can experience the symptoms of HFS (tingle, numbness, pain, swelling or redness of the palms of hands or soles). If patients have these symptoms, that will prevent normal activities. Early prevention and treatment can minimize discomfort and be beneficial for patients to continue the treatment.
In China, capecitabine has been widely used in clinical treatment. To date, no effective strategies have had been found to prevent or reverse HFS. After through clinical practice, we find that we can alleviate the patient's skin reactions, as soon as possible to improve the patient's quality of life after the use of Chinese herbal lotion.
The main pathological characteristics of HFS include basal keratinocytes vacuoles degeneration, skin and perivascular lymphocytic infiltration, cutin cell apoptosis and skin edema. Under the microscope we can see the inflammatory change: vasodilation, edema and leukocyte infiltration. Because of this kind of pathological changes, we consider HFS is a kind of inflammatory reaction. May be related to the overexpression of cyclo-oxygenase 2(COX2). HFS is similar to the dampness-heat syndrome of therapeutics of TCM. Therefore, we apply Chinese herbal lotion which can clear heat and promot diuresis, detoxicate, relieve swelling to alleviate symptoms of HFS.
Chinese medicine prescription for: Cortex Phellodendron 30g, Lithospermum erythrorhizon 30g, Alisma plantago-aquatica L. 30g, Ligusticum chuanxiong hort 30g, Angelica dahurica (Fisch.) Benth. et Hook 30g, Radix Radix Sophorae flavescentis 30g
Decoction method of use: 1, 000 ml, external use to wash/soak, affected part water temperature at 35 ~ 40℃, every time 20 mins, 2 to 3 times a day, after 7 days, symptoms can be eased.
Case report
Patient, male, 82 years old, imaging diagnosis of colon cancer with liver metastasis, clinical stage Ⅳ, colonoscopy pathology: Moderately differentiated adenocarcinoma Because of the age, the patient's relatives decided to choose simple oral capecitabine chemotherapy to treat the tumor. Oral capecitabine chemotherapy after 2 cycles, review of abdominal CT and CA199, it displayed that disease control was good. The patient did not appear obvious symptoms of HFS and only had the mild WBC decline caused by myelosuppression. It was back to normal after the treatment. The patient continued to the third cycle, gradually appeared limbs numbness and pain, redness and swelling, but no errhysis and no seepage. The patient started to take celebrex and vitamin B6, to wear comfortable footwear. When he continued to the fourth cycle, the patient beganed to appear feet skin dryness, peeling, errhysis and seepage, stabbing pain, feet swelling, numbness, and cannot walk. The symptoms of the hands were relatively mild, only local dry and scaly skin. After the diagnosis of the HFS level 3, suspension of oral chemotherapy, advising the patient to wash and soak the hands and the feet with Chinese herbal lotion according to the above prescription. After 1 week, the symptoms of errhysis and seepage, swelling and pain significantly reduced. Class at 2, He continued to wash 1 week, basic symptoms recovered. The patient restarted to take oral drug, at the same time with Chinese herbal lotion washing and soaking until the end of chemotherapy. He had not serious symptoms of HFS.
Discussion
As a new disease with clinical progress, so far, withdrawal and reduction are still the main methods of the treatment of HFS. Also we can use oral cox-2 inhibitors, vitamin B6, 300 mg/day and urea ointment topical measures to treat the symptoms of HFS. Curative effect is poor. And Chinese herbal lotion is easily accessible, cheap and relatively effective. Through the local application to the lesions, that can avoid the possible risk for liver and kidney function of oral medications.
Cortex Phellodendron has a very strong capability of clearing heat and drying damp. The bark of it contains a large numbers of berberine, a small amount of phellodendrine, magnoflorine and other alkaloids. These can be against many kinds of factors which caused by inflammation. Effectively promote angiogenesis and have the function of anti-ulcer. Animal experiments showed that Cortex Phellodendron in the process of antibacterial detoxification can effectively promote angiogenesis, eliminate inflammation and edema, improve microcirculation, promote wound healing and granulation tissue formation【1】. Lithospermum erythrorhizon has the function of cooling blood, promoting blood circulation, clearing heat and detoxification. It mainly contains naphthoquinone pigment which has the effects of allaying fever, anti-inflammation and analgesia【2】. Alisma plantago-aquatica L. has the effects of clearing damp and promoting diuresis and purge heat. It mainly contains Alisma terpene alcohols ABC and has the role of inducing diuresis for removing edema. Ligusticum chuanxiong hort can promote the circulation of blood and qi, stop pain and dispel wind. Mainly contains chuanxiongzine namely te - tramethylpyrazine, and the volatile oil which main component is ligustilide, 3 - butylphthalide and sabinene. These have the strong bacteriostasis and antihistamines【3】. Angelica dahurica (Fisch.) Benth. et Hook has the functions of dispelling pathogenic wind and removing dampness and relieving swelling and pain. Mainly includes cou-marins and volatile oil. The volatile oil mainly includes cyclhexene, 3 - methyl - ene - 6 - (1 - methylethl), octadecano, etc. Have the effects of anti-inflammation, bacteriostasis and analgesia. Radix Radix Sophorae flavescentis has the functions of clearing heat and drying damp, reducing swelling. It mainly contains alkaloids, Including matrine, sophoraflavoside and kushequinone【4】. They have very good relaxation effect to skin pruritus. Promote the growth and repair of nerve cells of damaged blood vessels, restore the vigour of subcutaneous capillary cells【5】. The six kinds of Chinese herbals cooperating together strengthen the effects of clearing heat and promoting diuresis, detoxication, relieving swelling.
The treatment of HFS with Chinese herbal lotion can relieve pain, reduce the classification, improve patient quality of life, and its security is good. The patients' compliance and satisfaction are high. This shows the features and advantages of external treatment of TCM. It deserves further clinical application.
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