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Wang Y, Meng L, Liu X. Capecitabine-associated gastrointestinal ulceration, haemorrhage, and obstruction: a pharmacovigilance analysis based on the FAERS. Front Pharmacol 2024; 15:1412938. [PMID: 38948471 PMCID: PMC11211585 DOI: 10.3389/fphar.2024.1412938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/03/2024] [Indexed: 07/02/2024] Open
Abstract
Background Capecitabine has been reported to be associated with severe gastrointestinal (GI) adverse drug reactions (gastrointestinal ulceration, haemorrhage, and obstruction). However, statistical correlations have not been demonstrated, and specific GI adverse drug reactions, such as GI obstruction, are not listed on its label. Aim We aimed to determine the associations between capecitabine and GI ulceration, haemorrhage, or obstruction among patients with breast cancer by examining data from the United States Food and Drug Administration Adverse Event Reporting System (FAERS). Methods We performed disproportionality analysis of GI ulceration, haemorrhage, and obstruction by evaluating the reporting odds ratio (ROR) and the information component (IC) with their 95% confidence intervals (CIs). Results We identified 279 patients with capecitabine-associated GI ulceration, haemorrhage, or obstruction reported between 1 January 2004 and 31 December 2020. One-fourth of the cases of GI ulceration, haemorrhage, or obstruction resulted in death. Capecitabine as a drug class had disproportionately high reporting rates for GI ulceration [ROR 1.94 (1.71-2.21); IC 0.80 (0.60-0.99)], haemorrhage [ROR 2.27 (1.86-2.76); IC 0.99 (0.69-1.28)], and obstruction [ROR 2.19 (1.63-2.95); IC 0.96 (0.51-1.40)]. Conclusion Pharmacovigilance research on the FAERS has revealed a slight increase in reports of GI ulceration, haemorrhage, and obstruction in capecitabine users, which may cause serious or deadly consequences. In addition to the adverse reactions described in the package insert, close attention should be paid to GI obstruction to avoid discontinuation or life-threatening outcomes.
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Affiliation(s)
- Yuwei Wang
- Department of Radiation Oncology, The Cancer Hospital of Chongqing University, Chongqing, China
| | - Long Meng
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Liu
- Department of Gastrointestinal Surgery, The Fifth People’s Hospital of Chongqing, Chongqing, China
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Pooyan A, Mansoori B, Wang C. Imaging of abdominopelvic oncologic emergencies. Abdom Radiol (NY) 2024; 49:823-841. [PMID: 38017112 DOI: 10.1007/s00261-023-04112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 11/30/2023]
Abstract
With advancements in cancer treatment, the survival rates for many malignancies have increased. However, both the primary tumors and the treatments themselves can give rise to various complications. Acute symptoms in oncology patients require prompt attention. Abdominopelvic oncologic emergencies can be classified into four distinct categories: vascular, bowel, hepatopancreatobiliary, and bone-related complications. Radiologists need to be familiar with these complications to ensure timely diagnosis, which ultimately enhances patient outcomes.
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Affiliation(s)
- Atefe Pooyan
- Department of Radiology, UW Radiology-Roosevelt Clinic, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
| | - Bahar Mansoori
- Department of Radiology, Section of Abdominal Imaging, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195-7115, USA
| | - Carolyn Wang
- Department of Radiology, Section of Abdominal Imaging, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195-7115, USA.
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Ojukwu K, Cox BK, Larson BK, Guindi M, Waters KM, Hutchings DA. Capecitabine-induced Gastrointestinal Injury Shows a Graft-Versus-Host Disease (GVHD)-like Pattern. Am J Surg Pathol 2023; 47:1160-1167. [PMID: 37493102 DOI: 10.1097/pas.0000000000002093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Capecitabine is a commonly used oral chemotherapeutic agent. Gastrointestinal (GI) side effects are clinically well-known, however, the histopathologic changes have not been comprehensively studied. This study describes the largest case series (8 patients) characterizing the histopathology of capecitabine-induced GI injury. All patients were adults (median age: 64.5 y, range: 61 to 76 y) and there was gender parity. Patients were receiving treatment for malignancies of the colorectum (n=5), breast (n=1), pancreas (n=1), and appendix (n=1). All had GI symptoms, including 7 with diarrhea and abdominal pain and 1 with melena. Five of 8 (63%) showed graft-versus-host disease (GVHD)-like histologic changes in small intestinal and/or colonic biopsies characterized by crypt disarray and dropout, crypt atrophy, dilated crypts lined by attenuated epithelium, and increased crypt apoptosis. Neuroendocrine cell aggregates were present in 4 of 5 cases. Four of 5 showed patchy prominence in lamina propria eosinophils. One patient receiving concomitant radiation therapy had a small intestinal biopsy showing regenerative changes. Two patients had histologically unremarkable biopsies. On follow-up, capecitabine was discontinued or dose-reduced in all patients. Three of 5 patients with a GVHD-like pattern had clinical improvement, whereas 2 died shortly after biopsy. One with regenerative changes also had radiation dose reduction and improved clinically. Two with unremarkable biopsies improved symptomatically. In summary, capecitabine-related GI injury shows a GVHD-like pattern. Knowledge of this is important to confirm the diagnosis as patients typically improve with dose reduction or discontinuation of the drug.
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Affiliation(s)
- Kenechukwu Ojukwu
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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Trontzas IP, Rapti VE, Syrigos NK, Gomatou G, Lagou S, Kanellis G, Kotteas EA. Capecitabine-associated enterocolitis: Narrative literature review of a rare adverse event and a case presentation. J Chemother 2023; 35:63-71. [PMID: 35014596 DOI: 10.1080/1120009x.2021.2025316] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Capecitabine is an oral 5-fluorouracil prodrug with antimetabolite activity commonly used in advanced colorectal and breast cancer. It presents with a generally good toxicity profile and most of the adverse events can be managed effectively. Enterocolitis is a rare, under-reported, but potentially fatal adverse event associated with capecitabine use. To the best of our knowledge, there are 21 cases of capecitabine-related enterocolitis reported in the literature. We herein present a narrative literature review of enteritis/colitis cases associated with capecitabine use, with highlight to the most common clinical presentation, common imaging and microscopic findings and management approach. We furthermore present a case of severe capecitabine-related enteritis.
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Affiliation(s)
- Ioannis P Trontzas
- 3rd Department of Internal Medicine, Oncology Unit, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
| | - Vasiliki E Rapti
- 3rd Department of Internal Medicine, Oncology Unit, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
| | - Nikolaos K Syrigos
- 3rd Department of Internal Medicine, Oncology Unit, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
| | - Georgia Gomatou
- 3rd Department of Internal Medicine, Oncology Unit, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
| | - Styliani Lagou
- 3rd Department of Internal Medicine, Oncology Unit, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
| | - George Kanellis
- Hematopathology Department, Evangelismos Hospital, Athens, Greece
| | - Elias A Kotteas
- 3rd Department of Internal Medicine, Oncology Unit, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
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Shao T, Zhang Y, Liu J, Chen J, Shu Q, Shou L. Capecitabine-induced enterocolitis: a case report and pharmacogenetic profile. Pharmacogenomics 2022; 23:953-959. [PMID: 36382550 DOI: 10.2217/pgs-2022-0124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Capecitabine is a widely-used antineoplastic drug, a prodrug to 5-fluorouracil which commonly induces gastrointestinal toxicity. Enterocolitis, as a rarely recognized gastrointestinal adverse effect (AE) of capecitabine, is potentially severe and usually results in antitumor treatment withdrawal. For the better management of severe AEs, pharmacogenetics is one promising field. Herein, we describe a case of capecitabine-induced enterocolitis presenting with severe diarrhea in order to improve recognition by clinicians. Moreover, we conduct a pharmacogenetic profile of the patient and review the current studies of gene polymorphisms of 5-fluorouracil-related diarrhea, hoping to offer a reference for further clinical pharmacogenetic practice in predicting capecitabine AEs showing diarrhea as the main symptom.
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Affiliation(s)
- Tianyu Shao
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
| | - Yao Zhang
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
| | - Jiaping Liu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
| | - Jialu Chen
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
| | - Qijin Shu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China.,Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310000, People's Republic of China
| | - Liumei Shou
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310000, People's Republic of China
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Khan M, Kleyner R, Abbasi S, Haider A. Capecitabine-Induced Enterocolitis. Cureus 2022; 14:e22855. [PMID: 35399470 PMCID: PMC8980194 DOI: 10.7759/cureus.22855] [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] [Accepted: 03/04/2022] [Indexed: 11/05/2022] Open
Abstract
Capecitabine is an oral fluoropyrimidine carbamate chemotherapy agent approved by the United States Food and Drug Administration (FDA) for the treatment of metastatic colorectal and breast cancer. The common side effects associated with it include gastrointestinal (GI) upset, abdominal pain, palmar-plantar erythrodysesthesia, fatigue, alopecia, leukopenia, neutropenia, thrombocytopenia, anemia, and hyperbilirubinemia. Although GI symptoms are relatively common, enterocolitis is one of the rare side effects of this drug. We present a case of 53-year-old female who developed severe enterocolitis leading to ileus secondary to capecitabine chemotherapy for metastatic breast cancer. She was treated successfully via conservative management.
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Furukawa T, Sasaki T, Ono Y, Kawano F, Takamatsu M, Mori C, Mie T, Yamada Y, Okamoto T, Takeda T, Kasuga A, Matsuyama M, Ozaka M, Takahashi Y, Sasahira N. A case of necrotic enteritis during neoadjuvant chemotherapy with gemcitabine and S-1 for resectable pancreatic ductal adenocarcinoma. Clin J Gastroenterol 2021; 14:1571-1577. [PMID: 34255287 DOI: 10.1007/s12328-021-01480-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022]
Abstract
Pancreatic cancer is the fourth leading cause of cancer-related death in Japan. Pancreatic cancer is categorized as resectable, borderline resectable, or unresectable based on the degree of adjacent vascular invasion and the presence of distant metastases. Neoadjuvant chemotherapy with gemcitabine and S-1 (NAC-GS) has recently become a standard option for resectable pancreatic cancer in Japanese patients. According to previous reports, GS is considered to be relatively safe and feasible treatment for Japanese patients, including the elderly. However, NAC-GS is occasionally associated with severe adverse events which may ultimately render the patient unfit for surgery. A 60-year-old man with resectable pancreatic cancer suffered from severe necrotic enteritis during NAC-GS, which required surgical resection. Considering the time course and histological findings of the resected bowel, S-1 was believed to be the causative agent. The low urinary dihydrouracil to uracil ratio also suggested possible dihydropyrimidine dehydrogenase deficiency, which may have hindered the metabolism of S-1 and contributed to the development of necrotic enteritis. Life-threatening enteritis occurs in approximately 0.3% of all patients who receive S-1. As initial symptoms are non-specific, patients should be instructed to lower the hurdle for contacting the hospital during NAC-GS.
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Affiliation(s)
- Takaaki Furukawa
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Takashi Sasaki
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
| | - Yoshihiro Ono
- Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Fumihiro Kawano
- Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Manabu Takamatsu
- Department of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Chinatsu Mori
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Takafumi Mie
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Yuto Yamada
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Takeshi Okamoto
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Tsuyoshi Takeda
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Akiyoshi Kasuga
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Masato Matsuyama
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Masato Ozaka
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Yu Takahashi
- Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Naoki Sasahira
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
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Mourad AP, De Robles MS. Chemoimmunotherapy-related enteritis resulting in a mechanical small bowel obstruction - A case report. Int J Surg Case Rep 2021; 79:131-134. [PMID: 33454633 PMCID: PMC7815460 DOI: 10.1016/j.ijscr.2020.12.096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 02/08/2023] Open
Abstract
The causes of a mechanical small bowel obstruction are diverse, several of which can be managed non-operatively. One such example is when an obstruction occurs due to an enteritis in the setting of chemo- and immunotherapy. Treatment is initially supportive in the form fluid resuscitation, gut rest, antiemetics and nasogastric decompression. Corticosteroids and biological agents may be considered under some circumstances.
Introduction and importance Mechanical small bowel obstruction (SBO) is amongst the commonest diagnoses encountered in surgical departments. Although the aetiology is frequently post-surgical adhesions, the condition can arise in a virgin abdomen and we now know several of these cases do not require acute operative management. Here we report one such case where a small bowel obstruction transpired due to enteritis in the setting of chemoimmunotherapy with no prior abdominal surgery. Case presentation A 62 year old male presented to our department with 2 days of vomiting and obstipation. This is on a background of metastatic non-small cell lung cancer for which he was due for his 4th cycle of carboplatin, pemetrexed and pembrolizumab. Computed Tomography (CT) of the abdomen demonstrated a segment of thickened distal small bowel without any mass lesion, along with upstream dilatation. The findings were consistent with a mechanical SBO due to enteritis. Infective causes were excluded. The patient successfully recovered with non-operative intervention in the coming days. Clinical discussion Enteritis is an established adverse effect of various chemoimmunotherapy agents, though a case severe enough to produce a mechanical bowel obstruction is exceptionally rare. We demonstrate through this case that the condition may resolve through conservative measures. Conclusion The diagnosis of chemoimmunotherapy-related enteritis producing an SBO although uncommon, should be considered in the relevant population. A non-operative approach may be appropriate under some circumstances.
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Affiliation(s)
- Ali P Mourad
- Department of Surgery, The Wollongong Hospital, Loftus Street, Wollongong, New South Wales, 2500, Australia.
| | - Marie Shella De Robles
- Department of Surgery, The Wollongong Hospital, Loftus Street, Wollongong, New South Wales, 2500, Australia
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