Document Detail

Toxic encephalopathy in elderly patients during treatment with capecitabine: literature review and a case report.
MedLine Citation:
PMID:  20926454     Owner:  NLM     Status:  MEDLINE    
Capecitabine is now-a-days rapidly replacing 5-Fluorouracil in daily clinical practice. Neurologic toxicity during a treatment with fluoropyrimidines, as 5-fluorouracil, represents a well-known side-effect, largely described in literature. Central nervous system (CNS) toxicity, mainly encephalopathy with or without seizures, occurs occasionally even when conventional doses are used. CNS toxicity incidence increases markedly when the blood-brain barrier is either overwhelmed or bypassed (Hildebrand J. Neurological complications of cancer chemotherapy. Curr Opin Oncol 2006; 18: 321-324). Peripheral nervous system (PNS) toxicity is more common because proximal and distal extremities of the peripheral nerves are not protected by a blood-brain like barrier and peripheral neuropathy remains a major limiting factor for the administration of conventional doses of several agents (Saif W, Wood TE, McGee PJ and Diasio RB. Peripheral neuropathy associated with capecitabine, Anticancer Drugs 2004;15: 767-771). Capecitabine is a prodrug of 5-fluorouracil, more easily administered by mouth; its transformation in 5-fluorouracil is performed in the liver. There are only a few reports on the toxic neurological side-effects of capecitabine. We describe in our report a rare case of toxic encephalopathy in a 82-year-old female, with a brief review of literature. In the literature reviewed, we found 12 neurologic episodes due to capecitabine lasting between a few days till some months. All clinical symptoms of the cases described in literature, obtained a complete regression with the discontinuation of capecitabine. A relation was not found with dihydropyrimidine dehydrogenase (DPD) mutation, also if pharmacologic and pharmacogenetic assessment should be done for this drug, especially in old patients. Toxic encephalopathy represents a rare event during capecitabine treatment and on the bases of the data found, is fairly managed in the clinical setting. The knowledge of the natural history of the toxic effect allows the use of the drug also in old patients.
Manuela Fantini; Lorenzo Gianni; Davide Tassinari; Stefania Nicoletti; Cinzia Possenti; Fabrizio Drudi; Michele Sintini; Laura Bagli; Emiliano Tamburini; Alberto Ravaioli
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Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2010-10-06
Journal Detail:
Title:  Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners     Volume:  17     ISSN:  1477-092X     ISO Abbreviation:  J Oncol Pharm Pract     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-29     Completed Date:  2012-02-10     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  9511372     Medline TA:  J Oncol Pharm Pract     Country:  England    
Other Details:
Languages:  eng     Pagination:  288-91     Citation Subset:  IM    
Oncology and Oncohematology Department, Rimini Hospital and Cancer Center of Romagna Meldola, Italy.
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MeSH Terms
Adenocarcinoma / drug therapy*,  secondary
Age Factors
Aged, 80 and over
Antimetabolites, Antineoplastic / adverse effects*
Bone Neoplasms / secondary
Colorectal Neoplasms / drug therapy*,  pathology
Deoxycytidine / adverse effects,  analogs & derivatives*
Fatal Outcome
Fluorouracil / adverse effects,  analogs & derivatives*
Neurotoxicity Syndromes / diagnosis,  etiology*
Patient Selection
Risk Assessment
Risk Factors
Reg. No./Substance:
0/Antimetabolites, Antineoplastic; 51-21-8/Fluorouracil; 6804DJ8Z9U/capecitabine; 951-77-9/Deoxycytidine

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