Preventing Doxorubicin-Induced Hand-Foot Syndrome

The study covered in this summary was published on Research Square as a preprint and has not yet been peer reviewed.

Key Takeaway

Why This Matters

  • PLD is a key drug for platinum-resistant recurrent ovarian cancer but the risk for hand-foot syndrome can occur in as many as 50% of patients. 

  • Wrist and ankle cooling during infusion is a common preventive strategy, but up to 30% of patients still get grade 2 or worse hand-foot syndrome.

  • Oral steroid therapy is generally provided in the second line to prevent a relapse.

  • The current study is the first to report the effect of combining both approaches.

  • Given the results, the authors say the combination should be considered a primary prevention strategy for hand-foot syndrome.

Study Design

  • The study included 74 patients with recurrent ovarian cancer who received PLD (with or without bevacizumab [Avastin]) at the University of Tokyo Hospital.

  • Patients wore ice packs around their wrists and ankles during their 90-minute PLD infusions and then took Dex in the following week (8 mg/day through day 5 then 4 mg/day on days 6 and 7).

  • The initial dose of PLD was 50 mg/m2 in 32 patients and 40 mg/m2 in the other 42 patients.

Key Results

  • Overall, 5 patients (6.8%) developed grade 2 or worse hand-foot syndrome and only 1 patient (1.4%) developed grade 3 or worse hand-foot syndrome. 

  • The grade 3 case was in a patient on 50 mg/m2.

  • There were no dose reductions as a result of hand-foot syndrome and only one discontinuation.


  • The study was a retrospective and observational with no control group.

  • Adverse events from dexamethasone were not sufficiently assessed.  


  • There was no funding reported, and the investigators didn’t report any competing interests.

This is a summary of a preprint research study, “Efficacy of cooling + oral dexamethasone as primary prevention for hand-foot syndrome associated with liposomal doxorubicin,” led by Katsuhiko Nara of the University of Tokyo, Japan, provided to you by Medscape. The study has not been peer reviewed. The full text can be found at

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: [email protected].

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