Hand-foot syndrome variant in a dihydropyrimidine dehydrogenase-deficient patient treated with capecitabine.
We present a case with dihydropyrimidine dehydrogenase (DPD) deficiency that manifested a variant of hand-foot syndrome (HFS). A 52-year-old man received capecitabine for adjuvant treatment of rectal cancer. On the ninth day of the first cycle, he presented to the clinic with a rash on the dorsum of both hands accompanied by symptoms of pain, erythema, swelling, and desquamation consistent with grade 3 HFS. The palms of his hands and soles of his feet were only tender with no apparent rash or discoloration. Dihydropyrimidine dehydrogenase activity was evaluated by radio assay using peripheral blood mononuclear cells. Dihydropyrimidine dehydrogenase activity was below normal: 0.12 nmol/minute/mg protein. Capecitabine was not resumed, and the rash resolved in 3 weeks with the use of pyridoxine and Udderly Smooth balm. Interestingly, HFS is rarely seen with 5-fluorouracil regimens containing selective DPD-inhibitors. This patient with DPD deficiency manifested a variant of HFS. The pharmacologic basis for the development of HFS in DPD-deficient patients warrants further investigation. Dihydropyrimidine dehydrogenase deficiency, if undiagnosed, can lead to death. In addition to severe to life-threatening toxicities akin to 5-fluorouracil, capecitabine can lead to unusual variants of common toxicities, including HFS, in DPD-deficient patients.
Saif
Muhammad Wasif
MW
Yale Cancer Center, New Haven, CT, USA. wasif.saif@yale.edu
Elfiky
Aymen
A
Diasio
Robert
R
D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant; D003677:Deficiency Diseases / Q000139:chemically induced; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D054067:Dihydropyrimidine Dehydrogenase Deficiency; D005472:Fluorouracil / Q000031:analogs & derivatives; D005533:Foot Dermatoses / Q000139:chemically induced* / Q000201:enzymology; D006229:Hand Dermatoses / Q000139:chemically induced* / Q000201:enzymology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010292:Paresthesia / Q000139:chemically induced / Q000201:enzymology; D011355:Prodrugs / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000188:drug therapy*; D013577:Syndrome
D000964:Antimetabolites, Antineoplastic; D011355:Prodrugs; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil