Treatment-resistant severe capecitabine-induced diarrhoea resolved with oral budesonide

Shumar, John; Junga, Zachary; Johnson, Jeptha; Goldkind, Lawrence

doi:10.1136/bcr-2019-231544

Cited by 3 publications

(5 citation statements)

References 13 publications

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…21,22 Patients with diarrhea were treated with loperamide, but other drugs can also be used to manage diarrhea as octreotide, tincture of opium, atropine and budesonide. 23,24 Moreover, patients with severe adverse reactions to capecitabine, especially diarrhea, should be checked for genetic polymorphisms in the dihydropyrimidine dehydrogenase gene. 23,24 Hand-foot syndrome is a common skin adverse reaction of capecitabine and usually starts or seems to be more severe within the first two cycles of treatment, 25 although there was no significant difference in the frequency of hand-foot syndrome between cycles in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…23,24 Moreover, patients with severe adverse reactions to capecitabine, especially diarrhea, should be checked for genetic polymorphisms in the dihydropyrimidine dehydrogenase gene. 23,24 Hand-foot syndrome is a common skin adverse reaction of capecitabine and usually starts or seems to be more severe within the first two cycles of treatment, 25 although there was no significant difference in the frequency of hand-foot syndrome between cycles in the present study. Among the patients included in our study, 53.9% had hand-foot syndrome and it is in accordance with the literature data.…”

Section: Discussionmentioning

confidence: 99%

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Adverse reactions and adherence to capecitabine: A prospective study in patients with gastrointestinal cancer

Visacri

Duarte

Lima

et al. 2021

J Oncol Pharm Pract

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Introduction Capecitabine is an oral anticancer drug which can cause some adverse reactions and the great challenge for its use is to ensure the medication adherence. The aim of this study was to analyze adverse reactions and adherence to capecitabine in patients with gastrointestinal cancer. Methods A prospective study was performed in a tertiary teaching hospital in Brazil. Outpatients undergoing capecitabine treatment for colorectal or gastric cancer were followed for three cycles of treatment. Patient demographic and clinical characteristics data were collected. Adverse reactions were analyzed using Common Terminology Criteria for Adverse Events (CTCAE) v.4. Adherence to capecitabine were evaluated using Morisky-Green and MedTake tests. Statistical analysis was conducted using Chi‐square, Fisher's exact and McNemer tests. Results One hundred and four patients were enrolled in this study, with a mean age was 58.5 ± 10.9 years; 51.0% were men and 51.0% Caucasian. Nausea and diarrhea were the most frequently reported adverse reactions (82.7% and 62.5%, respectively), followed by vomiting (54.8%), fatigue (54.8%), and hand-foot syndrome (53.9%). Nausea and diarrhea were also the most severe adverse reactions. Most patients were adherent to capecitabine in all cycles of treatment using the Morisky-Green test. Adherence increased significantly between cycle 1 and cycle 2 by MedTake test (p < 0.001). Some demographic and clinical characteristics were associated with adverse reactions (e.g., age and nausea, gender and nausea and vomiting) and capecitabine adherence (e.g., marital status and educational level) as well as some adverse reactions were associated with capecitabine adherence (hand-foot syndrome and nausea). Conclusions Clinical oncology pharmacists must provide patient information on the correct use of capecitabine, manage adverse reactions, and monitor adherence to treatment. Strategies to prevent non-adherence to capecitabine must be adopted to ensure the success of pharmacotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Adverse reactions and adherence to capecitabine: A prospective study in patients with gastrointestinal cancer

Visacri

Duarte

Lima

et al. 2021

J Oncol Pharm Pract

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“…3 Though adverse GI effects have been well-characterized clinically, description of the associated histopathologic features is limited and largely restricted to isolated case reports. [4][5][6][7][8][9][10][11][12][13][14][15][16] The current study, the largest series to date, characterizes the histopathologic features associated with capecitabine injury in GI mucosal biopsies.…”

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confidence: 97%

Capecitabine-induced Gastrointestinal Injury Shows a Graft-Versus-Host Disease (GVHD)-like Pattern

Ojukwu¹,

Cox²,

Larson³

et al. 2023

American Journal of Surgical Pathology

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Capecitabine is a commonly used oral chemotherapeutic agent. Gastrointestinal (GI) side effects are clinically well-known, however, the histopathologic changes have not been comprehensively studied. This study describes the largest case series (8 patients) characterizing the histopathology of capecitabine-induced GI injury. All patients were adults (median age: 64.5 y, range: 61 to 76 y) and there was gender parity. Patients were receiving treatment for malignancies of the colorectum (n=5), breast (n=1), pancreas (n=1), and appendix (n=1). All had GI symptoms, including 7 with diarrhea and abdominal pain and 1 with melena. Five of 8 (63%) showed graft-versus-host disease (GVHD)-like histologic changes in small intestinal and/or colonic biopsies characterized by crypt disarray and dropout, crypt atrophy, dilated crypts lined by attenuated epithelium, and increased crypt apoptosis. Neuroendocrine cell aggregates were present in 4 of 5 cases. Four of 5 showed patchy prominence in lamina propria eosinophils. One patient receiving concomitant radiation therapy had a small intestinal biopsy showing regenerative changes. Two patients had histologically unremarkable biopsies. On follow-up, capecitabine was discontinued or dose-reduced in all patients. Three of 5 patients with a GVHD-like pattern had clinical improvement, whereas 2 died shortly after biopsy. One with regenerative changes also had radiation dose reduction and improved clinically. Two with unremarkable biopsies improved symptomatically. In summary, capecitabine-related GI injury shows a GVHD-like pattern. Knowledge of this is important to confirm the diagnosis as patients typically improve with dose reduction or discontinuation of the drug.

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Capecitabine

2020

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Treatment-resistant severe capecitabine-induced diarrhoea resolved with oral budesonide

Cited by 3 publications

References 13 publications

Adverse reactions and adherence to capecitabine: A prospective study in patients with gastrointestinal cancer

Adverse reactions and adherence to capecitabine: A prospective study in patients with gastrointestinal cancer

Capecitabine-induced Gastrointestinal Injury Shows a Graft-Versus-Host Disease (GVHD)-like Pattern

Capecitabine

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