This single-center retrospective cohort study compared prophylactic medium-class topical corticosteroids (hydrocortisone butyrate 0.1% or clobetasone butyrate 0.05%, applied twice daily) versus no topical steroid in 110 colorectal cancer patients receiving adjuvant CapeOX chemotherapy between January 2022 and March 2025.
Grade ≥2 hand-foot syndrome (HFS) occurred in 23.1% of the topical steroid group (n=78) vs. 50.0% of the steroid-free group (n=32) — OR 0.30 (95% CI 0.13–0.72; P=0.012). The benefit held after multivariable adjustment (adjusted HR 0.407; 95% CI 0.206–0.803; P=0.0096). Grade ≥3 HFS was also lower (3.8% vs. 15.6%; P=0.045). No steroid-related adverse events were observed.
- Retrospective, non-randomized design with physician-determined allocation introduces confounding by indication that cannot be fully excluded. - No a priori sample size calculation; findings are exploratory and underpowered. - Dose reductions, treatment delays, and relative dose intensity were not systematically evaluated, leaving clinical impact on treatment delivery unclear.
Applying a mid-strength topical steroid (e.g., hydrocortisone butyrate 0.1%) to palms and soles from day 1 of capecitabine may cut the risk of grade ≥2 HFS roughly in half, with no observed safety signals. Until prospective RCT data are available (e.g., J-DIRECT trial), this low-cost strategy is a reasonable option to discuss with patients starting CapeOX.
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