Liu Yao, Hiramoto Brent, Kwok Janet, Ibrahim Ahmad, Tatishchev Sergei, Kang Irene, Modi Rushabh
Department of Internal Medicine, University of Southern California ‒ Internal Medicine Residency, Los Angeles, California, USA.
Division of Gastrointestinal and Liver Disease, Department of Internal Medicine, University of Southern California ‒ Keck School of Medicine, Los Angeles, California, USA.
Case Rep Oncol. 2021 Sep 21;14(3):1373-1379. doi: 10.1159/000517818. eCollection 2021 Sep-Dec.
Docetaxel is a taxane, which is a class of chemotherapy agent used in the treatment of multiple malignancies. It is known to have gastrointestinal side effects which can range from mild symptoms such as nausea and diarrhea to more severe complications such as neutropenic enterocolitis. In the current literature, taxanes have not been described to cause upper gastrointestinal bleeding and melena. Here, we present a case of a 54-year-old woman with breast cancer who developed dizziness, fatigue, and melena after receiving chemotherapy. Esophagogastroduodenoscopy revealed diffuse gastric erosions as well as ulceration and linear superficial lesions in the duodenum; biopsies from these sites showed taxane-induced toxicity. Her bleeding resolved with medical therapy and subsequent removal of docetaxel from her chemotherapy regimen. This case identifies upper gastrointestinal bleeding as a previously undescribed side effect of docetaxel therapy. Recent docetaxel use should be included in the differential diagnosis for upper gastrointestinal bleed, and diagnosis should lead to consideration of cessation of docetaxel or substitution with another chemotherapeutic agent.
多西他赛是一种紫杉烷类药物，属于一类用于治疗多种恶性肿瘤的化疗药物。已知它会引起胃肠道副作用，症状范围从轻微的如恶心和腹泻到更严重的并发症如中性粒细胞减少性小肠结肠炎。在当前文献中，尚未描述紫杉烷类药物会导致上消化道出血和黑便。在此，我们报告一例54岁乳腺癌女性病例，该患者在接受化疗后出现头晕、乏力和黑便。食管胃十二指肠镜检查显示弥漫性胃糜烂以及十二指肠溃疡和线性浅表病变；这些部位的活检显示为紫杉烷诱导的毒性。通过药物治疗以及随后从化疗方案中停用多西他赛，她的出血症状得到缓解。该病例确定上消化道出血是多西他赛治疗先前未描述的一种副作用。近期使用多西他赛应纳入上消化道出血的鉴别诊断中，诊断后应考虑停用多西他赛或换用另一种化疗药物。
