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Peripheral ischaemia (first report for S-1) in an elderly patient: case report A 69-year-old developed digital ischaemia during chemotherapy with gemcitabine and S-1. The man, who had a history of diabetes mellitus, started receiving combination chemotherapy with gemcitabine 400 mg/m2, on days 1 and 8, and S-1 80 mg/day, on days 1–14, every 3 weeks for advanced pancreatic cancer in December 2008 [routes not stated]. In July 2009, he experienced Raynaud’s phenomenon for which he was treated with vasodilators, antiplatelet drugs and prostaglandin; his chemotherapy was continued. In August 2009, chemotherapy was stopped, and the man was admitted with digital ischaemia. Initally, he received prostaglandin, vasodilators, antiplatelet drugs and antithrombin, with no improvement. He the received bosentan, but still had no improvement. In September 2009, he developed gangrenous changes in multiple fingers and toes. His ischaemia stabilised in December 2009, but he died from multiple organ failure in January 2010. Author comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of peripheral ischaemia associated with S-1. The WHO Adverse Drug Reactions database contained no reports of peripheral ischaemia associated with tegafur/gimeracil/oteracil potassium. Zaima C, et al. A Case of progressive digital ischemia after early withdrawal of gemcitabine and S-1 in a patient with systemic sclerosis. Japanese Journal of Clinical Oncology 41: 803-806, No. 6, Jun 2011. Available from: URL: http:// 803057525 dx.doi.org/10.1093/jjco/hyr045 - Japan

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Reactions 23 Jul 2011 No. 1361