{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T16:44:36Z","timestamp":1788799476017,"version":"build-2803163510"},"reference-count":63,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"\n Importance<\/jats:title>\n Hand-foot syndrome (HFS) is a common dose-limiting toxic effect of several chemotherapy agents, particularly capecitabine. Despite its substantial impact on the patient\u2019s quality of life and potential to compromise therapeutic efficacy, effective preventive strategies remain limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate and compare the efficacy of pharmacologic interventions for the prevention of chemotherapy-induced HFS through a network meta-analysis of published results of randomized clinical trials (RCTs).<\/jats:p>\n <\/jats:sec>\n \n Data Sources<\/jats:title>\n PubMed, Embase, and Cochrane CENTRAL were systematically searched from inception through November 2024 for relevant RCTs.<\/jats:p>\n <\/jats:sec>\n \n Study Selection<\/jats:title>\n Eligible studies were phase 2 or 3 RCTs that compared systemic or topical prophylactic interventions for the prevention of HFS.<\/jats:p>\n <\/jats:sec>\n \n Data Extraction and Synthesis<\/jats:title>\n Data extraction was performed by 2 reviewers, and disagreements were resolved by consensus. Risk of bias was assessed using the Cochrane Risk of Bias tool. A frequentist random-effects network meta-analysis was conducted.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary income was incidence of grade 2 or higher HFS. The secondary outcome was the incidence of any-grade HFS. Odds ratios (ORs) with 95% CIs were estimated. Ranking was assessed using P-scores and surface under the cumulative ranking (SUCRA) values.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Nineteen RCTs were included, of which 17 trials comprising 2192 patients (median [range] age, 57 [56-61] years) were analyzed for the primary outcome. Compared with placebo, topical silymarin (OR, 0.08; 95% CI, 0.01-0.71), diclofenac (OR, 0.23; 95% CI, 0.08-0.62), 400-mg pyridoxine (OR, 0.28; 95% CI, 0.09-0.88), and celecoxib (OR, 0.41; 95% CI, 0.18-0.95) significantly reduced grade 2 or higher HFS. Diclofenac (OR, 0.30; 95% CI, 0.13-0.69) and celecoxib (OR, 0.46; 95% CI, 0.22-0.94) also reduced overall HFS incidence. In contrast, silymarin and 400-mg pyridoxine did not show benefit for overall HFS, while mapisal increased HFS risk (OR, 3.04; 95% CI, 1.07-8.64). Ranking analyses showed the highest SUCRA value for silymarin (0.91) and diclofenac (0.76).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this systematic review and network meta-analysis, diclofenac and silymarin were the most effective preventive strategies for HFS, 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamadermatol.2026.0042","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T16:30:40Z","timestamp":1772641840000},"page":"386","source":"Crossref","is-referenced-by-count":4,"title":["Preventing Hand-Foot Syndrome in Patients With Cancer"],"prefix":"10.1001","volume":"162","author":[{"given":"Hemavathi","family":"Baskarane","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubham","family":"Sahni","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, 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