Wilks Andrew B, Saif Muhammad W
Tufts Medical Center, Tufts University School of Medicine.
Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine.
Cureus. 2017 Jan 24;9(1):e995. doi: 10.7759/cureus.995.
Capecitabine, an oral prodrug of 5-FU, has been approved by the FDA for use in patients with breast and colon cancers. In addition, capecitabine is commonly used in patients with other malignancies such as pancreatic, gastroesophageal, and hepatobiliary tract cancers. Though cerebellar toxicity is a rare but well-known side effect of intravenous 5-FU therapy, peripheral neuropathy with capecitabine has only been described in rare cases. In this case report, we describe a 79-year-old patient with locally advanced adenocarcinoma of the pancreas undergoing chemoradiation therapy with capecitabine who developed peripheral sensorimotor neuropathy. To the best of our knowledge, this is the first patient in the literature who was found to have two mutations (2R) of a 28 base-pair tandem repeat in the 5' promoter enhancer region (5'-TSER) on both alleles (2R/2R) of thymidylate synthetase (TYMS) gene, possibly responsible for the neurotoxicity.
卡培他滨是5-氟尿嘧啶（5-FU）的口服前体药物，已获美国食品药品监督管理局（FDA）批准用于治疗乳腺癌和结肠癌患者。此外，卡培他滨还常用于治疗其他恶性肿瘤患者，如胰腺癌、胃食管癌和肝胆道癌患者。虽然小脑毒性是静脉注射5-FU治疗罕见但广为人知的副作用，但卡培他滨引起的周围神经病变仅在少数病例中有描述。在本病例报告中，我们描述了一名79岁局部晚期胰腺腺癌患者，在接受卡培他滨同步放化疗时发生了周围感觉运动神经病变。据我们所知，这是文献中首例被发现胸苷酸合成酶（TYMS）基因两个等位基因（2R/2R）的5'启动子增强子区域（5'-TSER）存在28个碱基对串联重复的两个突变（2R），这可能是导致神经毒性的原因。
