Anti-inflammatory gel on the palms and soles from the first day of capecitabine

The trial. In D-TORCH, a single-site phase 3 double-blind trial in India, 264 people starting capecitabine for breast or gastrointestinal cancer were randomised to topical diclofenac or placebo gel for 12 weeks. Grade 2 or 3 hand-foot syndrome occurred in 3.8 per cent with diclofenac against 15.0 per cent with placebo, and capecitabine dose reductions because of it in 3.8 against 13.5 per cent. The gel was applied to the palms only.

The pooled evidence. A 2026 network meta-analysis of 13 trials (1983 patients, most on capecitabine) found topical diclofenac had the strongest effect on moderate to severe hand-foot syndrome (risk ratio 0.26) and was the only intervention that reduced chemotherapy modifications.

The doubt. In DICLO-HFS, a prospective observational study of 151 people in two Turkish centres, routine 1 per cent diclofenac gel did not reduce grade 2 or worse hand-foot syndrome against active monitoring (16.9 against 13.8 per cent). The Japanese J-DIRECT trial, a multicentre placebo-controlled phase 3 trial of diclofenac 0.1 per cent cream on palms and soles alongside standard prevention, was set up because D-TORCH did not test the soles and its control group had less hand-foot syndrome than earlier reports. How often diclofenac is offered with capecitabine has not been measured in any source read.