Highlights
- •Encephalopathy and leukoencephalopathy are the commonest clinico-radiologic features of capecitabine-related neurotoxicity.
- •Capecitabine-related neurotoxicity preponderated amongst females, but the clinico-radiologic features were similar in both genders.
- •Prognosis is excellent, and early recognition of neurotoxic symptoms and early cessation of capecitabine are important.
Abstract
Aim
To study the clinical and radiologic features of patients with capecitabine neurotoxicity.
Methods
We performed a retrospective analysis and systematic review on the clinical and radiologic
characteristics of all patients with capecitabine neurotoxicity reported in literature
between 2003 and 2020.
Results
24 cases including our patient were retrospectively analysed, with their clinical
and radiologic features summarized. Their median age was 59 years old (ranges from
31 to 82 years old). Encephalopathy was the predominant clinical symptom affecting
more than half (15/24, 63%) of the patients. This was followed by cerebellar ataxia
(10/24, 42%). Amongst the patients who had magnetic resonance imaging(MRI) brain imaging
performed, majority of them (18/23, 78%) had acute radiologic abnormalities. Leukoencephalopathy
was the commonest radiologic abnormality seen in more than half of the patients (15/23,65%).
Despite the preponderance of female patients in our study, there were no significant
statistical differences in the clinical and radiologic features. Short term prognosis
was excellent with complete resolution of neurologic symptoms observed in nearly all
of the patients (22/23, 96%).
Conclusion
Capecitabine-related neurotoxicity is an uncommon cause of toxic encephalopathy, with
a predilection for females. Clinical features are non-specific, with encephalopathy
being the commonest. Prognosis remains good with timely recognition, and cessation
of capecitabine. Future research looking into other pathogenic pharmacogenetic processes
should be conducted for further elucidation of these associations.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Future treatment options with capecitabine in solid tumours.Eur. J. Cancer. 2002; 38: S21-S25
- Toxic encephalopathy in elderly patients during treatment with capecitabine: literature review and a case report.J. Oncol. Pharm. Pract. Offl. Publ. Int. Soc. Oncol. Pharm. Pract. 2011; 17: 288-291
- Subacute reversible toxic encephalopathy related to treatment with capecitabine: a case report with literature review and discussion of pathophysiology.Neurotoxicology. 2014; 42: 8-11
- Toxic encephalopathy induced by capecitabine.Oncology 2004. 2004; 66: 331-335
- Capecitabine-induced cerebellar toxicity.Clin. Colorectal Cancer. 2006; 6: 70-71
- Posterior reversible encephalopathy syndrome (PRES) complicating newly-diagnosed diffuse large B-cell lymphoma.Clin. Lymphoma, Myeloma & Leukemia. 2014; 14: e111-e113
- Posterior reversible encephalopathy syndrome: a rare neurotoxicity after capecitabine.J. Oncol. Pharm. Pract. Offl. Publ. Int. Soc. Oncol. Pharm. Pract. 2020; 26: 1795-1801
- Teaching NeuroImages: transient mutism associated with splenium lesion in capecitabine-induced leukoencephalopathy.Neurology. 2019; 92: e1000-e1001https://doi.org/10.1212/WNL.0000000000007012
- Capecitabine induces both cardiomyopathy and multifocal cerebral leukoencephalopathy.Int. Heart J. 2013; 54: 417-420
- Capecitabine-induced leukoencephalopathy.Intern. Med. 2019; 58: 621-622
- Capecitabine-induced leukoencephalopathy involving the bilateral corticospinal tracts.J. Radiol. Case Rep. 2016; 10: 1-10
- Capecitabine-related neurotoxicity presenting as trismus.Clin. Colorectal Cancer. 2003; 3: 121-123
- Capecitabine-induced multifocal leukoencephalopathy: a report of five cases.Neurology. 2005; 65 (discussion 1685): 1792-1794
- Acute reversible toxic encephalopathy during capecitabine and oxaliplatin treatment.J. Oncol. Pharm. Pract. Offl. Publ. Int. Soc. Oncol. Pharm. Pract. 2019; 25: 497-501
- Capecitabine-induced cerebellar toxicity in a patient with metastatic colorectal cancer.J. Oncol. Pharm. Pract. Offl. Publ. Int. Soc. Oncol. Pharm. Pract. 2010; 16: 277-279
- Capecitabine-induced cerebellar toxicity and TYMS pharmacogenetics.Anti-Cancer Drugs. 2019; 30: 431-434
- 5-fluorouracil can cross brain-blood barrier and cause encephalopathy: should we expect the same from capecitabine? A case report on capecitabine-induced central neurotoxicity progressing to coma.Cancer Chemother. Pharmacol. 2006; 58: 276-278
- Posterior reversible encephalopathy syndrome following chemotherapy with oxaliplatin and a fluoropyrimidine: a case report and literature review.Asia-Pacific J. Clin. Oncol. 2012; 8: 115-122
- Capecitabine-induced oromandibular dystonia: a case report and literature review.Acta Oncol. 2008; 47: 1161-1165
- Oxaliplatin-induced posterior reversible encephalopathy syndrome with isolated involvement of pons.J. Cancer Res. Ther. 2015; 11: 1022
- First-line oral capecitabine therapy in metastatic colorectal cancer: a favorable safety profifile compared with intravenous 5-fluorouracil/leucovorin.Ann. Oncol. 2002; 13: 75
- 5-FU multifocal inflammatory leukoencephalopathy and dihydropyrimidine dehydrogenase deficiency.Neurology. 2001; 56: 110-112
- Toxic encephalopathy.Saf. Health Work. 2012; 3: 243-256
- Comparative pharmacology of oral fluoropyrimidines: a focus on pharmacokinetics, pharmacodynamics and pharmacomodulation.Br. J. Cancer. 2004 Aug 16; 91: 613-617
- Differences in toxicity between men and women treated with 5-fluorouracil therapy for colorectal carcinoma.Cancer. 2005; 103: 1165-1171
- Higher capecitabine AUC in elderly patients with advanced colorectal cancer (SWOGS0030).Br. J. Cancer. 2013; 109: 1744-1749https://doi.org/10.1038/bjc.2013.517
- Influence of sex and age on fluorouracil clearance.J. Clin. Oncol. 1992; 10: 1171-1175https://doi.org/10.1200/JCO.1992.10.7.1171
Article info
Publication history
Published online: September 30, 2022
Accepted:
September 27,
2022
Received in revised form:
September 27,
2022
Received:
July 11,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
