[Digital ischaemia and gemcitabine. Two new cases].

Area of Science:

• Oncology
• Vascular Medicine
• Pharmacology

Background:

• Digital ischemia is a known complication of cancer treatment, often linked to paraneoplastic syndromes.
• While various chemotherapy agents can cause adverse effects, gemcitabine has been anecdotally associated with vascular complications.
• Understanding the spectrum of chemotherapy-induced toxicities is crucial for patient safety and effective treatment.

Observation:

• Two distinct cases of digital ischemia are presented, strongly suggesting a link to gemcitabine administration.
• The first case involved a patient with metastatic squamous cell carcinoma treated with gemcitabine, who developed toxic vascularitis.
• The second case concerned a patient with bladder carcinoma who developed gemcitabine-induced arterial thrombosis.

Findings:

• Gemcitabine is implicated as a potential cause of digital ischemia, a complication that may be underestimated.
• Literature review identified nine additional cases of gemcitabine-associated digital ischemia.
• Other reported vascular side effects of gemcitabine include thrombotic microangiopathy and veno-occlusive disease.

Implications:

• Increased vigilance for digital ischemia is warranted in patients receiving gemcitabine, particularly those with pre-existing vascular conditions.
• Further research into the pathogenic mechanisms of gemcitabine-induced vascular toxicity is needed.
• Early recognition and management, including drug cessation, can lead to favorable outcomes.