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Intermediate dose 5-fluorouracil-induced encephalopathy.
Yeon-A Kim1, Hyun Cheol Chung, Hye Jin Choi
1Department of Internal Medicine, Yonsei Cancer Center, Seoul, Korea.
Japanese Journal of Clinical Oncology
|January 27, 2006
Summary
This case study highlights that lower doses of 5-fluorouracil (5-FU) chemotherapy can cause encephalopathy, a rare neurotoxicity. This condition, characterized by confusion and cognitive issues, resolved with conservative care and 5-FU cessation.
Area of Science:
- Oncology
- Neuroscience
- Pharmacology
Background:
- High-dose 5-fluorouracil (5-FU) is a known cause of acute neurotoxicity, specifically encephalopathy.
- Encephalopathy associated with lower doses of 5-FU is infrequently documented in medical literature.
Observation:
- A male patient with anal cancer developed confusion, cognitive dysfunction, and disorientation during 5-FU chemotherapy at 1000 mg/m(2) continuous infusion.
- Symptoms occurred during the second and fourth cycles, accompanied by hyperammonemia, but without focal neurological deficits or structural brain abnormalities.
- Neurological symptoms and elevated serum ammonia levels resolved completely after discontinuing 5-FU and providing conservative management.
Findings:
- Real-time PCR analysis revealed the patient's dihydropyrimidine dehydrogenase (DPD) mRNA levels increased significantly after 5-FU treatment (187% of initial), suggesting the encephalopathy was related to 5-FU catabolites rather than DPD deficiency.
- The patient's pre-treatment DPD mRNA levels were within the normal range (80% compared to reference group).
Implications:
- Encephalopathy should be considered a potential adverse effect even with lower-dose 5-FU chemotherapy regimens.
- Early recognition and discontinuation of 5-FU, alongside conservative care, are crucial for managing this neurotoxicity.
- This case expands the understanding of 5-FU-induced neurotoxicity, emphasizing the need for vigilance in patients receiving this chemotherapeutic agent.