Topical Recombinant Human Epidermal Growth Factor (rhEGF) gel plus urea ointment in the management of capecitabine-induced hand-foot syndrome: A case series with literature review

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Introduction Capecitabine-induced hand-foot syndrome (HFS) is a frequent and clinically relevant toxicity that may impair quality of life and lead to chemotherapy dose reduction or interruption. This study aimed to evaluate the effectiveness, safety, and clinical predictors of response to topical recombinant human epidermal growth factor (rhEGF) gel combined with urea ointment in patients with capecitabine-induced HFS. Methods This retrospective case series included a total of 83 patients with colorectal adenocarcinoma who developed Grade II–III capecitabine-induced HFS and received topical rhEGF gel plus urea ointment between January 2022 and December 2025. Results The median age was 61 years, and 49 patients (59.0%) were male. At baseline, 48 patients (57.8%) had Grade II HFS and 35 (42.2%) had Grade III HFS. After 3 weeks of treatment, 67 patients (80.7%) achieved at least a one-grade reduction in HFS severity. The median HFS grade significantly decreased after treatment (Wilcoxon, signed-rank, p < 0.001), with no cases of worsening. Improvements were observed in pain (70/70 affected patients; 100.0%), erythema (73/76; 96.1%), desquamation (60/60; 100.0%), and ulceration (18/24; 75.0% among affected patients). The median time to first documented improvement was 10 days. In an exploratory adjusted model, early treatment initiation within 7 days was associated with higher odds of response, whereas baseline Grade III HFS was associated with lower odds of response. No serious adverse events considered related to treatment were documented. Conclusions Topical rhEGF gel plus urea ointment was associated with rapid, well-tolerated improvement in capecitabine-induced HFS.