Lingyan Li, Linjun Wang, Wenjun Zhong
Oncology, Qiannan People's Hospital, Duyun, CHN.
Cureus. 2024 Dec 16;16(12):e75791. doi: 10.7759/cureus.75791. eCollection 2024 Dec.
Capecitabine is an oral prodrug metabolized into 5-fluorouracil (5-FU) and serves as a representative anticancer agent. While fluoropyrimidine treatment is usually well-tolerated, a subset of patients unfortunately experiences severe and sometimes life-threatening toxicity related to these compounds. This adverse reaction is frequently attributed to partial or complete deficiencies in the dihydropyrimidine dehydrogenase (DPD) enzyme. However, some patients may still suffer from severe toxic effects despite normal DPD screening results when treated with capecitabine. This paper presents the case of a Chinese woman with stage IIIB moderately differentiated adenocarcinoma of the lower rectum (cT3N2aM0) who exhibited severe toxicity after two weeks of neoadjuvant concurrent chemoradiotherapy in TNT mode at a low dose (825mg/m2 bid) of capecitabine. We found that this severe toxicity might be attributable to insufficient methylenetetrahydrofolate reductase (MTHFR) activity. To our knowledge, such reports are scarce in the medical literature concerning the Chinese population.
卡培他滨是一种口服前体药物，可代谢为5-氟尿嘧啶（5-FU），是一种典型的抗癌药物。虽然氟嘧啶治疗通常耐受性良好，但不幸的是，一部分患者会出现与这些化合物相关的严重且有时危及生命的毒性反应。这种不良反应通常归因于二氢嘧啶脱氢酶（DPD）酶的部分或完全缺乏。然而，一些患者在用卡培他滨治疗时，尽管DPD筛查结果正常，仍可能遭受严重的毒性作用。本文介绍了一名中国女性患者的病例，该患者患有直肠下段IIIB期中度分化腺癌（cT3N2aM0），在以低剂量（825mg/m2 bid）卡培他滨进行TNT模式的新辅助同步放化疗两周后出现严重毒性反应。我们发现这种严重毒性可能归因于亚甲基四氢叶酸还原酶（MTHFR）活性不足。据我们所知，在有关中国人群的医学文献中，此类报告很少见。
