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Abstract

We report the case of a 72-year-old woman suffering from bone metastatic breast cancer and treated with continuous intravenous 5 fluorouracil (5FU) chemotherapy, who presented with a bilateral asymmetric anterior optic neuropathy (ON). A deficiency of dihydropyrimidine dehydrogenase (DPD) was documented. Patients with DPD deficiency are at increased risk for developing unusual and/or severe toxicity to 5FU. We discuss the differential diagnosis of anterior ON and we suggest that 5FU can be responsible for optic nerve toxicity in patients with DPD deficiency.

Bilateral optic disc oedema and associated optic neuropathy in the setting of FOLFOX chemotherapy

“…However, given the biological plausibility of the mechanism and the close temporal association, we are of the opinion this should at least be considered. Delval and Klastersky [5] discount an ischaemic or vascular cause to 5-FU’s mechanism of optic neuropathy, based on the absence of an altitudinal field defect, flame-shaped haemorrhages of the disc, history of diabetes or hypertension, or evidence for cardioembolic disease in their patient. Given the absence of these risk factors (i.e.…”

“…5-FU has been reported as a possible cause of optic neuropathy in the past [5-8]. It is proposed that the transient visual disturbance experienced with 5-FU infusion treatment is in fact a result of short-posterior ciliary artery vasospasm, which further results in transient episodes of ischaemia to the optic nerve.…”

“…5-FU has been shown to have significant arterial vasospastic effects, which involves predominantly the coronary arteries, resulting in ischaemia and subsequent infarction of the myocardium, arrhythmias and sudden cardiac death [2-4]. Optic neuropathy has been documented previously when patients have been undergoing 5-FU treatment, with four identified cases of optic disc oedema and associated optic neuropathy in the setting of continuous 5-FU infusion [5-8]. Furthermore, the National Registry lists optic neuropathy as “possibly linked” to 5-FU treatment, highlighting several cases in the academic literature and within the registry [9].…”

“…Furthermore, the National Registry lists optic neuropathy as “possibly linked” to 5-FU treatment, highlighting several cases in the academic literature and within the registry [9]. The mechanism for optic neuropathy has not been documented, with some authors only postulating that 5-FU has a toxic effect on the optic nerve, which potentially may occur as a result of dihydropyrimidine dehydrogenase deficiency (DPD), which is the rate-limiting step in the metabolism of 5-FU [5]. Following is a case study where the patient developed optic disc oedema and associated optic neuropathy whilst undergoing 5-FU treatment, which further provides evidence for a possible association between 5-FU and optic neuropathy, providing the opportunity to discuss potential mechanisms for the associated toxicity.…”

Red American ginseng enhances the effect of fluorouracil on human colon cancer cells via both paraptosis and apoptosis pathways

“…Fluorouracil (5-FU) is a commonly used chemotherapeutic agent that interferes with the growth of cancer cells, including metastatic colorectal cancer cell (Pinedo and Peters, 1988). However, this drug has serious side effects including nausea, fatigue, and a decrease in blood cell counts (Delval and Klastersky, 2002). In the treatment of advanced cancer, higher 5-FU doses are not more effective yet increase side effects in both clinical and laboratory studies (Meregalli et al, 1998).…”