Clinical Report: Could Topical Delgocitinib Treat Capecitabine-Associated HFS?

Overview

This case series describes topical delgocitinib use for 6 weeks in two patients with grade 3 capecitabine-associated hand–foot syndrome (HFS) that persisted despite topical clobetasol and urea. HFS scores improved substantially in one patient, who continued capecitabine, but changed minimally in the other, who required capecitabine interruption; these two discordant outcomes do not establish efficacy.

Background

Capecitabine-associated HFS can cause burning, erythema, swelling, and, in more severe cases, painful desquamation, fissures, blistering, or ulceration. Although not life-threatening, it can impair daily activities and quality of life and may lead to chemotherapy dose reduction, interruption, or discontinuation. Management includes skin-care measures and symptomatic treatments such as emollients, urea, and high-potency topical corticosteroids, but established therapies are not consistently effective. Delgocitinib is a topical pan-JAK inhibitor approved in the European Union for adults with moderate-to-severe chronic hand eczema when topical corticosteroids are inadequate or inappropriate; its use for capecitabine-associated HFS is being explored.

Data Highlights

Key Findings

• Both patients had metastatic breast cancer and grade 3 capecitabine-induced HFS that remained inadequately controlled after 2 months of clobetasol propionate 0.05% cream once daily under occlusion plus urea 30%.
• After 6 weeks of topical delgocitinib, patient 1 improved from CTCAE grade 3 to grade 1, and the HFS-14 score decreased from 73.5 to 17.6; capecitabine was continued.
• Patient 2 had minimal change: CTCAE grade remained 3 and the HFS-14 score decreased from 76.5 to 67.6; capecitabine was interrupted.
• The source identifies prospective studies with larger populations as necessary to define the role of topical JAK inhibitors and determine which patients may be more likely to benefit.
• Related guideline context describes patient education, skin care, and avoidance of friction, pressure, heat, and trauma as core management measures; eviQ guidance identifies chemotherapy dose modification or interruption as the most effective interventions once HFS develops.

Clinical Implications

The case series documents a marked response in one patient and little change in the other, so it does not support a definitive estimate of benefit from topical delgocitinib for capecitabine-associated HFS. The source calls for larger prospective studies; established HFS management measures, including chemotherapy modification or interruption for severe disease, remain relevant.

Conclusion

Topical delgocitinib was associated with differing outcomes in two patients with refractory grade 3 capecitabine-associated HFS. Its therapeutic role remains uncertain and requires prospective evaluation.

Related Resources & Content

1. Article source, supplied case series, year not provided -- Could Topical Delgocitinib Treat Capecitabine-Associated Hand–Foot Syndrome?
2. eviQ, 2025 -- Hand-foot syndrome associated with chemotherapy
3. ESMO, year not provided -- Prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines
4. the asco post — Use of Topical Diclofenac Gel to Prevent Capecitabine-Associated Hand-Foot Syndrome
5. the asco post — Topical Diclofenac to Prevent Capecitabine-Associated Hand-Foot Syndrome
6. ASCO Publications — Topical Diclofenac for Prevention of Capecitabine-Induced Hand-Foot Syndrome: A Prospective Real-World Study
7. ASCO Publications — Topical Diclofenac for Prevention of Capecitabine-Induced Hand-Foot Syndrome: A Prospective Real-World Study
8. 1416-Hand-foot syndrome associated with chemotherapy | eviQ
9. Prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines
10. Comparing clinical practice guidelines on the prevention and management of chemotherapy-induced hand-foot syndrome
11. 1416-Hand-foot syndrome associated with chemotherapy | eviQ
12. Prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines☆ - Annals of Oncology
13. ONS SKIN TOXICITY SYMPTOM MANAGEMENT GUIDELINE
14. Topical Diclofenac for Prevention of Capecitabine-Associated Hand-Foot Syndrome: A Double-Blind Randomized Controlled Trial - PubMed
15. Effect of methylcobalamin on capecitabine induced hand-foot syndrome in patients with HER2 negative early breast cancer: multicentre, double blind, randomised, placebo controlled, phase 3 trial - PMC
16. Wongkraisri et al. BMC Cancer (2025) 25:275
17. Hand-foot syndrome prevention: pharmacological interventions-systematic review and network meta-analysis - PubMed
18. Drug Trials Snapshots: ANZUPGO | FDA
19. Preventive and Therapeutic Interventions for Anticancer Drug-induced Dermatologic Toxicities: a Scoping Review | Current Oncology Reports | Springer Nature Link