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Khunger N, Mittal S, Kataria S. Nail changes with chemotherapeutic agents and targeted therapies. Indian Dermatol Online J 2022; 13:13-22. [PMID: 35198463 PMCID: PMC8809183 DOI: 10.4103/idoj.idoj_801_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 05/15/2021] [Accepted: 11/27/2021] [Indexed: 11/08/2022] Open
Abstract
Patients on Cancer chemotherapeutic agents often develop nail changes most of which are only cosmetic concern and disappear on drug withdrawal. But some nail changes can be painful and disabling thereby affecting quality of life substantially. Different components of the nail unit include the nail matrix, nail bed, nail plate, the hyponychium, lunula, the proximal and lateral nail folds. In this article we review the nail changes induced by chemotherapeutics and targeted anticancer drugs, preventive measures and treatment options available.
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Li A, Li Y, Ge L, Li P, Li W. Onychomadesis associated with chemotherapy: case report and mini literature review. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:2373-2376. [PMID: 28860708 PMCID: PMC5565258 DOI: 10.2147/dddt.s139643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The side effects of chemotherapy drugs have increased in recent years, and some side effects can lead to onychomadesis. A 72-year-old woman who was diagnosed with an invasive ductal carcinoma of the right breast underwent a modified radical mastectomy in April 2015, followed by chemotherapy with capecitabine and nanoparticle albumin-bound paclitaxel (nab-paclitaxel). Subsequently, the patient experienced palmoplantar redness, pain, onycholysis, a transparent serous exudate, and onychomadesis. The chemotherapy was discontinued, and the patient was treated with oral vitamin B6, a polymyxin ointment, and a high-energy red light. The palmoplantar redness and pain were alleviated after 1 month. However, although her fingernails improved, dysesthesia symptoms remained, and all her toenails exhibited defects or deformities at a 24-month follow-up. The symptoms of this disorder should be recognized by dermatologists.
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Affiliation(s)
- Ang Li
- Department of Dermatology, Qianfoshan Hospital, Shandong University, Jinan, People's Republic of China.,Department of Clinical Medicine, Queen Mary School, Medical School, Nanchang University, Nanchang, People's Republic of China
| | - Yanqiong Li
- Department of Dermatology, Qianfoshan Hospital, Shandong University, Jinan, People's Republic of China.,Department of Clinical Medicine, Taishan Medical college, Tai'an, People's Republic of China
| | - Lingzhi Ge
- Department of Dermatology, Affiliated First Hospital of Taishan Medical college, Tai'an, People's Republic of China
| | - Ping Li
- Department of Dermatology, Qianfoshan Hospital, Shandong University, Jinan, People's Republic of China.,Department of Clinical Medicine, Taishan Medical college, Tai'an, People's Republic of China
| | - Wenfei Li
- Department of Dermatology, Qianfoshan Hospital, Shandong University, Jinan, People's Republic of China
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Capriotti K, Capriotti J, Pelletier J, Stewart K. Chemotherapy-associated paronychia treated with 2% povidone-iodine: a series of cases. Cancer Manag Res 2017; 9:225-228. [PMID: 28721095 PMCID: PMC5500570 DOI: 10.2147/cmar.s139301] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Nail changes are known to occur during the use of chemotherapy for a variety of malignancies, particularly those treated with taxanes and EGFR inhibitors. There are currently no actively recruiting prospective clinical trials investigating potential treatments. There are also no US Food and Drug Administration-approved medical treatments for chemotherapy-associated paronychia and no consensus on the best way to treat these common chemotherapy-induced events. Methods A retrospective review of all cases presenting to a single dermatology private practice from June 2016 to January 2017 identified nine patients with chemotherapy-associated paronychia seeking treatment. Each patient was prescribed a topical solution comprised of 2% povidone–iodine in a dimethylsulfoxide vehicle that was prepared by a licensed compounding pharmacy. Patients were seen at 3 week and 6 week follow-up visits. Results All 9/9 patients demonstrated complete or partial resolution. The number of nails involved for each patient ranged from 4–12. There were a total of 58 nails affected in the case series, and 44/58 (76%) resolved overall. The treatment was well tolerated. Conclusion The topical povidone–iodine/dimethylsufoxide solution described is very effective in alleviating the signs and symptoms of paronychia associated with chemotherapy. This novel combination warrants further investigation in randomized, controlled trials to further elucidate its clinical utility.
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Affiliation(s)
- Kara Capriotti
- Veloce BioPharma LLC, Fort Lauderdale, FL.,Bryn Mawr Skin and Cancer Institute, Rosemont, PA
| | - Joseph Capriotti
- Veloce BioPharma LLC, Fort Lauderdale, FL.,Plessen Ophthalmology Consultants, Christiansted, VI, USA
| | - Jesse Pelletier
- Veloce BioPharma LLC, Fort Lauderdale, FL.,Plessen Ophthalmology Consultants, Christiansted, VI, USA
| | - Kevin Stewart
- Veloce BioPharma LLC, Fort Lauderdale, FL.,Plessen Ophthalmology Consultants, Christiansted, VI, USA
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Capriotti K, Capriotti J, Lessin S, Wu S, Goldfarb S, Belum V, Lacouture M. The risk of nail changes with taxane chemotherapy: a systematic review of the literature and meta-analysis. Br J Dermatol 2015; 173:842-5. [DOI: 10.1111/bjd.13743] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K. Capriotti
- Bryn Mawr Skin and Cancer Institute; Rosemont PA U.S.A
| | - J.A. Capriotti
- Ophthalmology Consultants PC; Juan F. Luis Hospital; Christiansted VI U.S.A
| | - S. Lessin
- Bryn Mawr Skin and Cancer Institute; Rosemont PA U.S.A
| | - S. Wu
- Division of Medical Oncology; Department of Medicine; State University of New York at Stony Brook; Stony Brook NY U.S.A
- Division of Hematology and Oncology; Department of Medicine; Northport VA Medical Center; Northport NY U.S.A
| | - S. Goldfarb
- Breast Cancer Medicine Service; Memorial Sloan Kettering Cancer Center; New York NY U.S.A
| | - V.R. Belum
- Dermatology Service; Memorial Sloan Kettering Cancer Center; New York NY U.S.A
| | - M.E. Lacouture
- Dermatology Service; Memorial Sloan Kettering Cancer Center; New York NY U.S.A
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Hardin J, Haber R. Onychomadesis: literature review. Br J Dermatol 2015; 172:592-6. [DOI: 10.1111/bjd.13339] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 12/29/2022]
Affiliation(s)
- J. Hardin
- Division of Dermatology; Richmond Road Diagnostic and Treatment Centre; University of Calgary; 1820 Richmond Road SW Calgary AB T2T5C7 Canada
| | - R.M. Haber
- Division of Dermatology; Richmond Road Diagnostic and Treatment Centre; University of Calgary; 1820 Richmond Road SW Calgary AB T2T5C7 Canada
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Zaias N, Escovar SX, Zaiac MN. Finger and toenail onycholysis. J Eur Acad Dermatol Venereol 2014; 29:848-53. [PMID: 25512134 DOI: 10.1111/jdv.12862] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/20/2014] [Indexed: 11/29/2022]
Abstract
Onycholysis - the separation of the nail plate from the nail bed occurs in fingers and toenails. It is diagnosed by the whitish appearance of the separated nail plate from the nail bed. In fingers, the majority is caused by trauma, manicuring, occupational or self-induced behavior. The most common disease producing fingernail onycholysis is psoriasis and pustular psoriasis. Phototoxic dermatitis, due to drugs can also produce finger onycholysis. Once the separation occurs, the environmental flora sets up temporary colonization in the available space. Finger onycholysis is most common in women. Candida albicans is often recovered from the onycholytic space. Many reports, want to associate the yeast as cause and effect, but the data are lacking and the treatment of the candida does not improve finger onycholysis. A reasonable explanation for the frequent isolation of Candida and Pseudomonas in fingernail onycholysis in women, is the close proximity the fingers have to the vaginal and gastrointestinal tract. Fifty per cent of humans harbour C. albicans in the GI tract and it is frequently carried to the vagina during hygienic practices. Finger onycholysis is best treated by drying the nail 'lytic' area with a hair blower, since all colonizing biota are moisture loving and perish in a dry environment. Toenail onycholysis has a very different etiology. It is mechanical, the result of pressure on the toes from the closed shoes, while walking, because of the ubiquitous uneven flat feet producing an asymmetric gait with more pressure on the foot with the flatter sole.
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Affiliation(s)
- N Zaias
- Dermatology Mt. Sinai Medical Center, Miami Beach, Florida
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Cutaneous reactions to chemotherapeutic drugs and targeted therapies for cancer: part I. Conventional chemotherapeutic drugs. J Am Acad Dermatol 2014; 71:203.e1-203.e12; quiz 215-6. [PMID: 25037800 DOI: 10.1016/j.jaad.2014.04.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 04/07/2014] [Accepted: 04/09/2014] [Indexed: 02/07/2023]
Abstract
Conventional chemotherapy continues to be an important part of cancer management, but may cause various cutaneous reactions because it disturbs specific cell cycle phases. The alkylating agents cyclophosphamide, ifosfamide, and thiotepa can produce hyperpigmentation, while hypersensitivity reactions can be seen with platinum alkylating agents. Antimetabolites vary in reactions from exanthematous to bullous skin lesions. 5-fluorouracil and its derivatives and liposomal doxorubicin and daunorubicin are characteristically known to cause hand-foot syndrome, while bleomycin can cause fibrosis and flagellate dermatitis. Several hypersensitivity reactions may also occur from mitotic inhibitors and topoisomerase inhibitors. These different characteristic presentations are important to dermatologists in identifying the correct diagnosis and management for the cancer patient.
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Walker G, Lane N, Parekh P. Photosensitive lichenoid drug eruption to capecitabine. J Am Acad Dermatol 2014; 71:e52-3. [DOI: 10.1016/j.jaad.2014.01.884] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/21/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
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Gutiérrez-Pascual M, Sols-Candela M, Pinedo F, López-Estebaranz J. Toxic Dermatitis Due to Capecitabine: Presentation of 2 Cases and Literature Review. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70077-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Toxicodermia por capecitabina. Presentación de dos casos clínicos y revisión de la literatura. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)70834-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Affiliation(s)
- Mohammad Jafferany
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of Washington School of Medicine, Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.
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Heidary N, Naik H, Burgin S. Chemotherapeutic agents and the skin: An update. J Am Acad Dermatol 2008; 58:545-70. [PMID: 18342708 DOI: 10.1016/j.jaad.2008.01.001] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 01/07/2008] [Accepted: 01/10/2008] [Indexed: 12/17/2022]
Abstract
UNLABELLED Chemotherapeutic agents give rise to numerous well described adverse effects that may affect the skin, hair, mucous membranes, or nails. The mucocutaneous effects of longstanding agents have been extensively studied and reviewed. Over the last 2 decades, a number of new molecular entities for the treatment of cancer have been approved by the United States Food and Drug Administration (FDA). This article reviews the cutaneous toxicity patterns of these agents. It also reviews one drug that has not received FDA approval but is in use outside the United States and is important dermatologically. Particular emphasis is placed on the novel signal transduction inhibitors as well as on newer literature pertaining to previously described reactions. LEARNING OBJECTIVES At the completion of this learning activity, participants should able to list the newer chemotherapeutic agents that possess significant mucocutaneous side effects and describe the range of reactions that are seen with each drug. In addition, they should be able to formulate appropriate management strategies for these reactions.
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Affiliation(s)
- Noushin Heidary
- Ronald O. Perelman Department of Dermatology, New York University, New York, USA
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Vaccaro M, Barbuzza O, Guarneri F, Guarneri B. Nail and periungual toxicity following capecitabine therapy. Br J Clin Pharmacol 2008; 66:325-6. [PMID: 18384441 DOI: 10.1111/j.1365-2125.2008.03174.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hogeling M, Howard J, Kanigsberg N, Finkelstein H. Onycholysis Associated with Capecitabine in Patients with Breast Cancer. J Cutan Med Surg 2008; 12:93-5. [DOI: 10.2310/7750.2008.07028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Onycholysis, which is separation of the nail plate from the nail bed at its distal and lateral attachments, can cause pain and impair function and is a well-known side effect of traditional chemotherapeutic agents. Objectives: We present two cases of onycholysis associated with capecitabine in women with advanced breast cancer, who were initially referred for evaluation of onychomycosis and review the literature on capecitabine. Conclusion: Owing to the increased frequency of use of capecitabine for different cancers, physicians should be aware of this side effect.
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Affiliation(s)
- Marcia Hogeling
- From the Division of Dermatology, University of Ottawa, Ottawa, ON, and University of Western Ontario, London, ON
| | - Jessica Howard
- From the Division of Dermatology, University of Ottawa, Ottawa, ON, and University of Western Ontario, London, ON
| | - Nordau Kanigsberg
- From the Division of Dermatology, University of Ottawa, Ottawa, ON, and University of Western Ontario, London, ON
| | - Harvey Finkelstein
- From the Division of Dermatology, University of Ottawa, Ottawa, ON, and University of Western Ontario, London, ON
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Vázquez-Bayo C, Rodríguez-Bujaldón A, Jiménez-Puya R, Galán-Gutiérrez M, Moreno-Giménez J. Hiperpigmentación secundaria a capecitabina. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70114-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Vázquez-Bayo C, Rodríguez-Bujaldón A, Jiménez-Puya R, Galán-Gutiérrez M, Moreno-Giménez J. Capecitabine Induced Hyperpigmentation. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tejera A, Bosch RJ, López N, Herrera E. Onicolisis con exudado del hiponiquio secundaria a quimioterapia con paclitaxel y capecitabina. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:536-8. [PMID: 17067535 DOI: 10.1016/s0001-7310(06)73459-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 39-year-old female patient who consulted due to onycholysis, subungual hyperkeratosis and presence of exudate in the big toe of the right foot. The lesions appeared during oncology treatment of bilateral breast cancer with lymphatic metastases with paclitaxel every three weeks and capecitabine daily. Clinical manifestations are due to the involvement of the nail bed caused by the chemotherapy. These should be known and taken into account due to the increased use of this type of cytotoxic agents.
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Affiliation(s)
- Antonio Tejera
- Servicio de Dermatología, Hospital Clínico Universitario Virgen de la Victoria, Málaga. España
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Abstract
Due to its high metabolic rate, skin represents one of the major target organs of chemotherapy-associated toxicity. Reactions range from common, nonspecific exanthematous eruptions to rare but distinctive cutaneous lesions that may not become apparent until a drug transitions from clinical trials to widespread oncologic use. The challenge of the physician is to recognize reaction patterns that reflect a drug reaction, identify a likely causative drug, and determine whether the reaction is a dose-limiting toxicity. This review will focus on the cutaneous side effects of the newer classes of chemotherapy drugs, including targeted monoclonal antibody therapy and small molecule inhibitors.
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Affiliation(s)
- Aimee S Payne
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Muñoz A, Barceló R, Rubio I, Mañé JM, Ferreiro J, López-Vivanco G. Onycholysis associated with capecitabine in combination with irinotecan in two patients with colorectal cancer. J Natl Cancer Inst 2003; 95:1252-3. [PMID: 12928355 DOI: 10.1093/jnci/djg034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chen GY, Chang TW, Chen WC. Exudative hyponychial dermatitis associated with capecitabine and docetaxel combination chemotherapy for metastatic breast carcinoma: report of three cases. Br J Dermatol 2003; 148:1071-3. [PMID: 12786853 DOI: 10.1046/j.1365-2133.2003.05272.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Malet-Martino M, Martino R. Clinical studies of three oral prodrugs of 5-fluorouracil (capecitabine, UFT, S-1): a review. Oncologist 2002; 7:288-323. [PMID: 12185293 DOI: 10.1634/theoncologist.7-4-288] [Citation(s) in RCA: 272] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although 5-fluorouracil (5-FU) was first introduced in 1957, it remains an essential part of the treatment of a wide range of solid tumors. 5-FU has antitumor activity against epithelial malignancies arising in the gastrointestinal tract and breast as well as the head and neck, with single-agent response rates of only 10%-30%. Although 5-FU is still the most widely prescribed agent for the treatment of colorectal cancer, less than one-third of patients achieve objective responses. Recent research has focused on the biomodulation of 5-FU to improve the cytotoxicity and therapeutic effectiveness of this drug in the treatment of advanced disease. As all the anticancer agents, 5-FU leads to several toxicities. The toxicity profile of 5-FU is schedule dependent. Myelotoxicity is the major toxic effect in patients receiving bolus doses. Hand-foot syndrome (palmar-plantar erythrodysesthesia), stomatitis, and neuro- and cardiotoxicities are associated with continuous infusions. Other adverse effects associated with both bolus-dose and continuous-infusion regimens include nausea and vomiting, diarrhea, alopecia, and dermatitis. All these reasons explain the need for more effective and less toxic fluoropyrimidines. In the first part of this review, we briefly present the metabolic pathways of 5-FU responsible for the efficacy and toxicity of this drug. This knowledge is also necessary to understand the target(s) of biomodulation. The second part is devoted to a review of the literature on three recent prodrugs of 5-FU, i.e., capecitabine, UFT (ftorafur [FTO] plus uracil), and S-1 (FTO plus 5-chloro-2,4-dihydroxypyridine plus potassium oxonate). The pharmacological principles that have influenced the development of these new drugs and our current knowledge of the clinical pharmacology of these new agents, focusing on antitumor activity and toxicity, are presented. The literature was analyzed until March 2002. This review is intended to be as exhaustive as possible since it was conceived as a work tool for readers wanting to go further.
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Affiliation(s)
- M Malet-Martino
- Groupe de RMN Biomédicale, Laboratoire des IMRCP, Université Paul Sabatier, Toulouse, France.
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Current awareness in pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2002; 11:169-74. [PMID: 12004884 DOI: 10.1002/pds.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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