Palmar-plantar hyperpigmentation with capecitabine in adjuvant colon cancer.
BACKGROUND
Capecitabine (XELODA) is a chemotherapeutic agent used widely in the treatment of adjuvant/metastatic colon cancer and metastatic breast cancer. It is usually well tolerated; however, one of the major side effects, hand-foot syndrome (HFS), can be quite disabling. Hyperpigmentation is currently not part of the grading system of HFS, but may be a marker of developing toxicity.


METHODS
Here, we describe three patients treated with adjuvant capecitabine for colon cancer (a 49-year-old East Indian man, a 58-year-old Asian woman, and a 54-year-old Aboriginal man) who developed moderate to severe HFS requiring delay and dose reduction. In every case, toxic side effects were preceded by hyperpigmented macules on the hands and feet.


CONCLUSIONS
Hyperpigmentation of the hands and feet is a rare side effect with capecitabine chemotherapy and appeared to predict impending grade 2 HFS in our patients. Clinicians and health care workers in oncology should be aware of this potential side effect; however, further investigation is required to determine whether or not palmar-plantar hyperpigmentation should be included in the spectrum of HFS. Hyperpigmentation may also be more common in the non-Caucasian populations but more research is required to determine the ethnic distribution of this finding.
Vickers
Michael M
MM
Department of Medical Oncology, Tom Baker Cancer Center, 1331 29th Street, NW Calgary, Alberta, Canada.
Easaw
Jacob C
JC
D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects; D000069287:Capecitabine; D003110:Colonic Neoplasms / Q000188:drug therapy; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000031:analogs & derivatives*; D005533:Foot Dermatoses / Q000139:chemically induced*; D006229:Hand Dermatoses / Q000139:chemically induced*; D006801:Humans; D017495:Hyperpigmentation / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged
D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil