Dihydropyrimidine dehydrogenase (DPD) is a metabolic enzyme that is crucial in 5-fluorouracil (5-FU) degradation. A deficiency in it is associated with the occurrence of adverse events following fluoropyrimidine-based therapies. We describe a case of toxicity grade 5 after the administration of capecitabine and oxaliplatin in a patient with stage III colorectal cancer and DPD congenital deficiency, which was identified later. Several polymorphisms have been associated with the global toxicity of 5-FU; however, genetic tests are low in sensitivity and therefore they cannot as yet be used as prescreening techniques in clinical practice.

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notas clínicas0Respuesta completa tras tratamiento con bioquimioterapia en un caso de melanoma cutáneo diseminado Complete response in a patient with a metastatic cutaneous melanoma M.J. Bermejo-Pérez, E. Villar-chamorro, M. lemos-simosomo, c. García-González, a.M. Galeote-Miguel REsUMEnFundamento. El pronóstico del melanoma diseminado es muy sombrío. Actualmente no hay consenso sobre el tratamiento estándar en primera línea para el melanoma metastático. Se presenta un caso por su comportamiento excepcional.Resultados. Varón de 43 años diagnosticado en 1999 de melanoma maligno estadio IIA. En mayo de 2000 se objetivaron metástasis hepáticas y esplénicas. Recibió 6 ciclos de bioquimioterapia (cisplatino y DTIC junto con interleukina-2 e interferón-α) cada 21 días y otros 6 ciclos con inmunoterapia sola (interleukina-2 e interferón-α). Actualmente el paciente sigue vivo y sin evidencia de enfermedad.conclusión. El melanoma cutáneo metastático, en ocasiones, presenta una inusual evolución favorable. Es de esperar que los métodos de detección de marcadores moleculares logren determinar factores implicados en este tipo de respuesta y que los nuevos tratamientos dirigidos consigan mantener esta tendencia positiva.Palabras clave. Melanoma. Quimioterapia. Inmunoquimioterapia. aBstRactBackground. The management of patients with disseminated disease is a difficult problem. There is currently no consensus on the standard first-line treatment for metastatic melanoma. We present a case because of his exceptional evolution. Results.A 43 year old male diagnosed in 1999 with malignant melanoma stage IIA. In May 2000, hepatic and splenic metastases were detected. He received 6 cycles of biochemotherapy (cisplatin and DTIC, plus interleukin-2 and interferon-α) and another 6 cycles with single immunotherapy (interleukin-2 and interferon-α). Today, the patient is still alive and without evidence of disease.conclusion. Metastatic cutaneous melanoma, sometimes, presents and unusual and favourable evolution. In the near future, the methods of detection of molecular markers are expected to identify factors involved in this type of response. Furthermore, new targeted therapies may become essential to maintain this positive trend.