Study of Pyridoxine for Hand-Foot Syndrome

Asan Medical Center389 enrolled

Overview

Although pyridoxine has been used empirically for the prevention of capecitabine associated hand-foot syndrome (HFS), its efficacy needs to be demonstrated in prospective controlled trials. The investigators therefore performed a prospective randomized double-blind study to determine whether pyridoxine 200 mg/day can prevent the development of HFS when given concurrently with capecitabine. The investigators also tested the ability of pyridoxine to treat primary occurrence of grade 2-3 HFS.

Although pyridoxine has been used empirically for the prevention of capecitabine associated HFS, its efficacy needs to be demonstrated in prospective controlled trials. We estimated that the HFS rate with placebo and pyridoxine would be 0.35 and 0.18, respectively, and we therefore calculated that a sample size of 345 patients would be necessary to detect these hazard rates with an 80% power (β=0.2) and two-sided significance level of α=0.05. We assumed a follow up loss rate of 10%, thus requiring 380 patients to be randomized. Chemotherapy-naive patients with gastrointestinal tract cancers who were scheduled for capecitabine-containing chemotherapy were assigned to receive oral pyridoxine or placebo in randomized double-blind placebo controlled study. Pyridoxine 100 mg b.i.d was prescribed to the patients in the pyridoxine group, identical placebo 100 mg b.i.d was prescribed in the placebo group by the closed envelop randomization. Patients were stratified by chemotherapy regimen: capecitabine alone (X), capecitabine and cisplatin (XP), or docetaxel, capecitabine, and cisplatin (DXP). Patients were observed until NCI CTC grade 2 or 3 HFS developed or capecitabine-containing chemotherapy ended. Patients in the placebo group who developed grade 2 or 3 HFS were randomized to receive pyridoxine or placebo for the next chemotherapy cycle to determine whether pyridoxine could improve HFS, and the same treatment was continued for 2 chemotherapy cycles.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Enrollment

389

Conditions

Hand-foot Syndrome

Interventions

PyridoxineDRUG

100mg BID/daily, Per oral

PlaceboDRUG

placebo 100mg BID/daily, Per oral

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Gastrointestinal tract cancer patients treated with capecitabine-containing chemotherapy as a first-line treatment were randomly allocated to concurrent treatment with pyridoxine or placebo. * All patients were 18 to 70 years old * Had Eastern Cooperative Oncology Group (ECOG) performance status of 2 or lower * An estimated life expectancy \> 3 months * Adequate bone marrow function, including white blood cell (WBC) count of \>3500 cells/㎕ and platelet count of \>100000/㎕ * Adequate renal function (serum creatinine concentration \<1.5 mg/㎗) * Adequate liver function with (serum bilirubin concentration \<1.5 mg/㎗, transaminase \<3 times the upper normal limit, and serum albumin \>2.5 mg/㎗). Exclusion Criteria: * Previous treatment for HFS * Hypersensitivity to pyridoxine * A combination of other malignancies * Serious illnesses or medical conditions * Immune suppression or positive human immunodeficiency virus (HIV) serology * Pregnant or lactating women.

Outcomes

Primary Outcomes

Cumulative Dose of Capecitabine Until the Development of Grade 2 or Higher Hand-foot Syndrome

A total administered dose of capecitabine until the development of grade 2 or higher hand-foot syndrome during the chemotherapy.

Time frame: Up to 2 years

Secondary Outcomes

Number of Patients With Hand-foot Syndrome

Number of patients with any grade of hand-foot syndrome

Time frame: Up to 2 years

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.