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Tumeric Prevents Chemotherapy Induced Hand Foot Syndrome

Xeloda (Capecitabine) is the oral form of  chemotherapy agent 5-Fluorouracil  (5-FU) which is administered intravenously. 

Both drugs are widely used in a broad range of cancers. The mechanism of action is inhibition of mitosis (cell division).   

One of the most common side effects of these drugs is HAND-FOOT SYNDROME or palmar-plantar erythrodysesthesia.  Hand-Foot syndrome presents with redness, swelling and pain, tingling, burning and sensitivity to touch on the palms of the hands and the soles of the feet. Severe cases may include cracked, flaking or peeling skin, painful blisters, ulcers or sores, severe pain and difficulty walking or using the hands.

While etiology is not certain it is hypothesized that these drugs cause capillary fragility and subsequent leakage of drugs into and damage of  the surrounding tissue.

fhs

Other commonly used chemotherapy agents  which result in Hand - Foot syndrome include 5-Fluorouracil, Capecitabine, Cytarabine, Docetaxel, Doxorubicin, Doxil and Paclitaxel. These drugs are widely used in Breast, Ovarian and Gastrointestinal Cancers.  

Not all patients who receive these drugs develop Hand-Foot Syndrome. The symptoms typically appear with the first dose administration in 40-50 percent of patients at grade 2 or higher.

turmeric-as-cure

Grade 1: painless erythema or dysesthesia, no impairment

Grade 2: painful erythema, swelling, tingling, numbness, dryness, cracking, Desquamation, activity is impaired

Grade 3: strong pain, ulceration, blistering, erythema, limited self-sufficiency

For drugs administered via IV infusion, cold (Ice) gloves and booties that constrict capillaries reduce local exposures in the hands and feet and must be worn during infusions and for several therapy to hands and feet concurrently with chemotherapy infusions. 

Capcetabine increases COX-2 expression in both tumors and healthy tissues.

A double blind placebo controlled study in which oral COX2 inhibitor celecoxib was administered to patients over a 2 year period while receiving capecitabine or capecitabine plus oxaliplatin demonstrated a significant decrease in the incidence and intensity of symptoms.

The phytochemical curcumin derived from Rhizoma Curcuma longa interacts with over 100 genes that impact tumor cell behavior and metabolism. Curcumin is known to decrease COX2 expression along with expression of  pro-inflammatory NFkB, TNFa, IL1B, IL6 and IL8.  

foot-hand-syndromeIn a human study researchers administered turmeric at a dose of 4 g/day (2 pills 12 hours apart) starting at the beginning of capecitabine treatment and lasting six weeks. The study included 40 patients whose mean age was 62 years. Most were female (80%), 52% had breast cancer, and 47.5% had GI tumors. After the first cycle of capecitabine treatment, 11 of 40 patients developed HFS (27.5%; 95% CI [15, 42]), whereas four patients developed HFS equal or superior to grade 2 (10%; 95% CI [3.3, 23]).. The study concluded that  turmeric combined with capecitabine seems to produce a lower rate of HFS, especially grade 2 or higher. 

Comments

  • There were no contra-indications to utilizing turmeric concurrently with capecitabine
  • A significant therapeutic dose of 4 grams per day was used.   In my practice I prefer to use the more concentrated isolate curcumin and dose at 2-4 grams per day.  This would yield more inflammation control.   
  • Turmeric falls into the category of herbs that “Move Stagnant Blood” in Chinese Medicine.  One of the properties of curcumin is inhibition of platelet aggregation.

References:

Curcuma longa (Turmeric) for Prevention of Capecitabine-Induced Hand-Foot Syndrome: A Pilot Study

Vanessa Armenio Scontre , MD,Janine Capobiango Martins , MD, et al 

Jnl Diet Supp Pages 606-612 | Published online: 02 Nov 2017

 https://doi.org/10.1080/19390211.2017.1366387 PMID: 2909565

The effect of COX-2 inhibitor on capecitabine-induced hand-foot syndrome in patients with stage II/III colorectal cancer: a phase II randomized prospective study.Zhang RX, Wu XJ, Lu SX, Pan ZZ, Wan DS, Chen G.
J Cancer Res Clin Oncol. 2011 Jun;137(6):953-7. doi: 10.1007/s00432-010-0958-9. Epub 2010 Nov 27.
PMID: 21113620 Clinical Trial.

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green-tea-extract

Green Tea Extract Reduces Severity of Radiation Dermatitis

The use of a solution containing a green tea extract has been shown to reduce both the incidence and severity of radiation-induced dermatitis in women undergoing adjunctive radiotherapy for breast cancer. This was the conclusion of a phase 2 randomized, placebo-controlled trial by a team of Chinese researchers.

Data from the World Health Organization indicates that in 2020, there were 2.3 million women diagnosed with breast cancer. In the treatment of women with breast cancer, radiation therapy is widely used conjunction with other therapies such as surgery, chemotherapy and hormonal therapies.  A common and frequent adverse effect of radiotherapy is radiation-induced dermatitis (RID) suffered by millions of women.

green-tea

The purpose of the current  study was to investigate the safety, tolerability and preliminary effectiveness of topical epigallocatechin-3-gallate (EGCG) for radiation dermatitis in patients with breast cancer receiving adjuvant radiotherapy.

A  solution of green tea extract  sprayed on the radiated areas of the skin reduced severity of radiation-induced dermatitis.

The Chinese team recruited women with breast cancer undergoing postoperative radiotherapy and randomized them (2:1) to receive either the green tea extract or placebo (normal saline solution).  These solutions were sprayed to the whole of the radiation field from the first day of therapy until two weeks after completion of treatment. 

A total of 165 women with a median age of 46 years were enrolled and randomized to EGCG, the primary catechin found in green tea or placebo.

The onset of radio-dermatitis was delayed by 2-3 weeks and the intensity and severity of the symptoms were significantly decreased in the treated group.  No skin toxicity was observed.

The authors concluded that prophylactic use of a green tea extract significantly reduced both the incidence and severity of RID and that it has the potential to become a new choice for skin care in women receiving radiotherapy.

Topical green tea extract supports restoration of skin integrity and control of inflammatory cytokines and oxidative stress in the skin. Green tea extract also reduces the acute skin-induced reactions including pain and sensations of burning, itching, pulling and tenderness.

Dr. Chilkov: Practical Application:

green-tea-leavesTopical Green Tea Extract Spray

To make a medicinal water extract: Place 8 organic green tea bags into a 16 oz glass jar or glass container.  Pour boiling water over the tea bags, cover immediately and steep for one hour.   After it has cooled to room temperature store covered in the refrigerator.  When ready to use transfer water extract to a a glass spray bottle.  Apply liberally to the radiation field before and after each radiotherapy session and three times daily for 3 weeks after the last radiotherapy session.  

Fresh Aloe Vera Gel poultice

Areas where skin is most impacted can be covered with. mashed fresh aloe vera gel and covered with a large gauze bandage.   This can easily be held in place underneath a sports bra or leotard or similar.  Apply fresh aloe gel twice daily. Allow to be in contact with the skin for several hours or overnight.  If you do not have access to a live aloe vera plant or fresh aloe gel you can use alcohol free aloe vera juice or aloe vera gel commonly found in natural foods stores.    Aloe Vera is the botanical of choice for repair of radiation damaged skin.

Topical Calendula Oil (not extract) is also a soothing topical anti-inflammatory agent for radiation induced dermatitis.  If the skin is very damaged, saturate a 4x4” gauze square and place over the affected area.

References:

Zhao H et al. 

Efficacy of Epigallocatechin-3-Gallate (EGCG)in Preventing Dermatitis in Patients With Breast Cancer Receiving Postoperative Radiotherapy: A Double-Blind, Placebo-Controlled, Phase 2 Randomized Clinical Trial JAMA Dermatol 2022

Zhao H, et al. 

Phase I study of topical epigallocatechin-3-gallate (EGCG) in patients with breast cancer

receiving adjuvant radiotherapy. Br J Radiol 2016; 89: 20150665.

Kyle T. Amber, BS et al

The Use of Antioxidants in Radiotherapy-Induced Skin Toxicity 

Integrative Cancer Therapies 2014, Vol. 13(1) 38–45

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