title: Unpredicted severe toxicity after 5-fluorouracil treatment due to dihydropyrimidine dehydrogenase deficiency.
abstract: Dihydropyrimidine dehydrogenase (DPD) is the initial and rate-limiting enzyme in the catabolism of 5-fluorouracil (5-FU). Thus, patients with a DPD deficiency are at risk of developing severe 5-FU-associated toxicity. A 37-year-old female with gastric cancer underwent a curative operation, followed by adjuvant chemotherapy consisting of 5-FU and epirubicin. After the first cycle of chemotherapy, the patient manifested grade 2 mucositis and febrile neutropenia, and when her treatment was subsequently continued with doxifluridine she developed severe mucositis and febrile neutropenia. A PCR study revealed that her DPD mRNA level was lower than that in a control group. Thus, when considering the routine use of 5-FU for the treatment of cancer patients, an analysis of DPD activity or screening for DPD mutations is warranted in confined patients who experience unpredicted severe toxicity after initial 5-FU administration, even though DPD deficiency is a rare metabolic defect.
authors.affiliation: Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Baek
authors.forename: Jong Gwang
authors.initials: JG
authors.lastname: Kim
authors.forename: Shi Nae
authors.initials: SN
authors.lastname: Kim
authors.forename: Dong Hwan
authors.initials: DH
authors.lastname: Kim
authors.forename: Sang Kyun
authors.initials: SK
authors.lastname: Sohn
authors.forename: Young Jun
authors.initials: YJ
authors.lastname: Hong
authors.forename: Kyu Bo
authors.initials: KB
authors.lastname: Lee
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant; D054067:Dihydropyrimidine Dehydrogenase Deficiency; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects*; D006801:Humans; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil