Korean J Intern Med.  2006 Mar;21(1):43-45. 10.3904/kjim.2006.21.1.43.

Unpredicted Severe Toxicity after 5-Fluorouracil Treatment due to Dihydropyrimidine Dehydrogenase Deficiency

• Baek JH
• Kim JG
• Kim SN
• Kim DH
• Sohn SK
• Hong YJ
• Lee KB

• KMID: 1782251
• DOI: http://doi.org/10.3904/kjim.2006.21.1.43

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.

Keyword

Dihydrouracil dehydrogenase; Fluorouracil; Stomach neoplasms

MeSH Terms

Stomach Neoplasms/complications/*drug therapy/surgery
Risk Factors
Risk Assessment
Humans
Fluorouracil/*adverse effects
Female
*Drug Toxicity
Dihydrouracil Dehydrogenase (NADP)/*deficiency
Chemotherapy, Adjuvant
Antimetabolites, Antineoplastic/*adverse effects
Adult
Adenocarcinoma/complications/*drug therapy/surgery