[Digital ischemia in two patients treated with gemcitabine]

Area of Science:

• Oncology
• Vascular Medicine
• Pharmacology

Background:

• Gemcitabine and platinum salts are common chemotherapy agents used for various cancers.
• Vascular toxicity is a known, though less common, side effect of gemcitabine and platinum-based therapies.
• Digital ischemia, characterized by reduced blood flow to the fingers and toes, can be a severe manifestation of vascular toxicity.

Observation:

• Two patients, one with urothelial carcinoma and another with mesothelioma, developed digital ischemia during chemotherapy.
• The first patient received gemcitabine and carboplatin, experiencing ischemia in multiple fingers.
• The second patient, treated with gemcitabine alone, developed ischemia in specific fingers.

Findings:

• Gemcitabine-induced vascular toxicity may be potentiated by platinum salts.
• Literature suggests dose-dependent toxicity for gemcitabine, with higher doses linked to thrombotic microangiopathy.
• Platinum salt vascular toxicity is not dose-dependent.

Implications:

• Prompt interruption of chemotherapy and supportive care are vital for managing chemotherapy-induced digital ischemia.
• Iloprost and aspirin demonstrated efficacy in treating digital ischemia in these cases.
• Awareness of potential vascular complications is essential for oncologists managing patients on gemcitabine and platinum-based regimens.