1.Unpredicted Severe Toxicity after 5-Fluorouracil Treatment due to Dihydropyrimidine Dehydrogenase Deficiency.
Jin Ho BAEK ; Jong Gwang KIM ; Shi Nae KIM ; Dong Hwan KIM ; Sang Kyun SOHN ; Young Jun HONG ; Kyu Bo LEE
The Korean Journal of Internal Medicine 2006;21(1):43-45
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.
Stomach Neoplasms/complications/*drug therapy/surgery
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Risk Factors
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Risk Assessment
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Humans
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Fluorouracil/*adverse effects
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Female
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*Drug Toxicity
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Dihydrouracil Dehydrogenase (NADP)/*deficiency
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Chemotherapy, Adjuvant
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Antimetabolites, Antineoplastic/*adverse effects
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Adult
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Adenocarcinoma/complications/*drug therapy/surgery