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5-Fluorouracil-associated severe hypertriglyceridaemia with positive rechallenge
Bianca Giacomuzzi Moore1,2, Anna Durigova2, Faiza Lamine3,4
1Oncology, CHUV, Lausanne, Switzerland bianca.giacomuzzi-moore@chuv.ch.
BMJ Case Reports
|December 19, 2023
Summary
Severe hypertriglyceridaemia (HTG) linked to 5-fluorouracil (5-FU) chemotherapy is rare. This case highlights a patient experiencing grade 4 HTG, emphasizing the need for monitoring during FOLFOX treatment.
Area of Science:
- Oncology
- Pharmacology
- Biochemistry
Background:
- Chemotherapy-induced hypertriglyceridaemia (HTG) is a significant adverse event.
- Severe HTG (>11.3 mmol/L) poses risks of pancreatitis and cardiovascular disease.
- Capecitabine is known to cause HTG, but 5-fluorouracil (5-FU) is not typically associated with it.
Observation:
- A patient developed grade 4 HTG (TG up to 37.1 mmol/L) after the ninth cycle of adjuvant FOLFOX (5-FU and Oxaliplatin).
- Fenofibrate treatment and dietary changes were initiated.
- Chemotherapy was paused, resumed, but severe HTG recurred, leading to permanent discontinuation.
Findings:
- This case reports a rare instance of 5-FU-associated severe HTG.
- Hypertriglyceridaemia resolved after chemotherapy cessation, with triglycerides returning to normal levels (2.1 mmol/L).
- Fenofibrate was discontinued without recurrence of HTG at 3 months post-chemotherapy.
Implications:
- Clinicians should consider monitoring triglyceride levels in patients receiving 5-FU-based chemotherapy, particularly FOLFOX.
- Early detection and management of chemotherapy-induced HTG are crucial to prevent serious complications.
- Further research may be warranted to understand the specific mechanisms of 5-FU-induced HTG.
