Capecitabine
- PDF / 184,892 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 97 Downloads / 153 Views
1
★S
Various toxicities, including first report of aortic dissection, in an elderly patient: case report A 77-year-old woman developed severe toxicities, including acute aortic dissection, during capecitabine therapy for metastatic breast cancer. The woman presented with pulmonary metastases in September 2008, and began receiving twice daily capecitabine 1000 mg/m2 for 14 days of every 3-week cycle [route not stated]. She experienced stomatitis and grade 2 skin toxicity during the first cycle; no dosage adjustment was required. During the second cycle, her stomatitis progressed to full-body mucositis with grade 3 vomiting, rash, diarrhoea, anorexia and grade 4 asthenia. The woman did not consult her physician, but interrupted therapy for 1 day (day 11), before completing the second therapy cycle. Her relatives then alerted the oncologist of her poor condition, and she was hospitalised 5 days after completion of the second cycle. On admission, severe asthenia, abdominal pain and continuous episodes of vomiting and diarrhoea were present; she had lost 4kg since capecitabine initiation. Her consciousness was altered, and she was lethargic; her ECOG performance status had increased from 0 to 4. Examination revealed a BP of 120/70mm Hg, dehydration and severe oral epithelial loss, a macular-papular skin reaction with desquamation, and severe diffuse abdominal pain on palpation. CT scans confirmed a treatment response, but also showed an aortic dissection below the origin of the superior mesenteric artery, and a left lateral wall thrombus. She required intensive supportive care, including hydration, antimycotics, antibiotics, analgesics and proton pump inhibitors. The dissection had not evolved after 1 week, and she underwent surgical resection and reconstruction of the dissected aorta. Pathological findings of the resected specimen included vasa-vasorum neutrophilic and chronic arteritis in the arterial wall, absent endothelium, and the presence of sclerotic plaques and thrombotic material [outcome not clearly stated]. Author comment: "We report the case of a life-threatening toxicity that developed in a woman treated with capecitabine. . . [T]he absence of risk factors or previous arterial events in the woman’s history, the timing of the dissection, the associated life-threatening toxicities that developed, and the arterial injury from fluoropyrimidines described in experimental models led us to hypothesize that a cause-effect correlation should be considered." Sclafani F, et al. Case report of acute aortic dissection during treatment with capecitabine for a late recurrence of breast cancer. Chemotherapy (Basel) 56: 203-207, No. 3, Jun 2010. Available from: URL: http:// 803031155 dx.doi.org/10.1159/000316331 - Italy
»
Editorial comment: A search of AdisBase, Medline, Embase and the WHO ADR database did not reveal any previous reports of aortic dissection associated with capecitabine.
0114-9954/10/1314-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 14 Aug 2010 No. 1314
Data Loading...
