Atypical toxicity associated with 5-fluororacil in a DPD-deficient patient with pancreatic cancer. Is ethnicity a risk factor?

Muhammad Wasif Saif, Sandra Seller, Robert B Diasio

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Context: Fluoropyrimidines constitute the backbone of chemotherapy regimens for GI tumors, including pancreatic cancer where it is used either as a radiosensitizer or as second-line after failing gemcitabine. While normal dihydropyrimidine dehydrogenase (DPD) enzyme activity is rate limiting in 5-fluorouracil (5-FU) catabolism, its deficiency could increase concentrations of bioavailable 5-FU anabolic products leading to 5-FU related toxicity syndrome. The most common toxicities include myelosuppression, stomatitis, neuropathy, and diarrhea. The prevalence of this autosommal codominently inherited pharmacogenetic syndrome is approximately 3-5% in the Caucasian population and 8% in the African-American population. Case report: We present here a case of an African-American patient with pancreatic cancer who developed a desquamative skin rash on the face, tunk, and forearms as the worst rash (grade 3) following 5-FU bolus that led to the investigation of DPD enzyme. Measurement of DPD activity by radioisotopic assay methods described previously revealed an abnormally low level of 0.087 nmol/min/mg protein (reference range: 0.182-0.688 nmol/min/mg protein). She was treated toxicity with intravenous steroids and antihistamine therapy. Further 5-FU therapy was discontinued. Conclusions: This case suggest that the pattern of toxicities associated with 5-FU can vary, especially in patients with different ethnic backgrounds (whites versus non-whites). These findings become of further importance as our recent study suggests that DPD deficiency may be more common among African-Americans.

Original languageEnglish (US)
Pages (from-to)226-229
Number of pages4
JournalJournal of the Pancreas
Volume9
Issue number2
StatePublished - Mar 2008

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Dihydrouracil Dehydrogenase (NADP)
Pancreatic Neoplasms
Fluorouracil
African Americans
gemcitabine
Exanthema
Dihydropyrimidine Dehydrogenase Deficiency
Stomatitis
Pharmacogenetics
Histamine Antagonists
Enzymes
Forearm
Population
Diarrhea
Reference Values
Proteins
Steroids
Drug Therapy
Therapeutics

Keywords

  • Capecitabine
  • Exanthema
  • Fluorouracil

ASJC Scopus subject areas

  • Endocrinology
  • Gastroenterology

Cite this

Atypical toxicity associated with 5-fluororacil in a DPD-deficient patient with pancreatic cancer. Is ethnicity a risk factor? / Saif, Muhammad Wasif; Seller, Sandra; Diasio, Robert B.

In: Journal of the Pancreas, Vol. 9, No. 2, 03.2008, p. 226-229.

Research output: Contribution to journalArticle

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abstract = "Context: Fluoropyrimidines constitute the backbone of chemotherapy regimens for GI tumors, including pancreatic cancer where it is used either as a radiosensitizer or as second-line after failing gemcitabine. While normal dihydropyrimidine dehydrogenase (DPD) enzyme activity is rate limiting in 5-fluorouracil (5-FU) catabolism, its deficiency could increase concentrations of bioavailable 5-FU anabolic products leading to 5-FU related toxicity syndrome. The most common toxicities include myelosuppression, stomatitis, neuropathy, and diarrhea. The prevalence of this autosommal codominently inherited pharmacogenetic syndrome is approximately 3-5{\%} in the Caucasian population and 8{\%} in the African-American population. Case report: We present here a case of an African-American patient with pancreatic cancer who developed a desquamative skin rash on the face, tunk, and forearms as the worst rash (grade 3) following 5-FU bolus that led to the investigation of DPD enzyme. Measurement of DPD activity by radioisotopic assay methods described previously revealed an abnormally low level of 0.087 nmol/min/mg protein (reference range: 0.182-0.688 nmol/min/mg protein). She was treated toxicity with intravenous steroids and antihistamine therapy. Further 5-FU therapy was discontinued. Conclusions: This case suggest that the pattern of toxicities associated with 5-FU can vary, especially in patients with different ethnic backgrounds (whites versus non-whites). These findings become of further importance as our recent study suggests that DPD deficiency may be more common among African-Americans.",
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