5 fluorouracil (5-FU)-related neurotoxicity is a rare and severe complication of 5-FU administration. Dihydropyrimidine dehydrogenase (DPD) deficiency is associated with an increased risk of serious adverse reactions due to its role in 5-FU metabolism. We report a case of acute reversible neurotoxicity with global areas of diffusion restriction in a patient with colorectal adenocarcinoma being treated with leucovorin calcium, 5-fluorouracil, and oxaliplatin (FOLFOX) without DPD deficiency following uridine triacetate administration.
Fluorouracil Error Ends Tragically, But Application of Lessons Learned Will Save. Institute for Safe Medication Practices2007. Accessed November, 11, 2020
2.
KiSSJeongJMKimSH, et al.A case of neurotoxicity following 5-fluorouracil-based chemotherapy. Korean J Intern Med Mar. 2002;17(1):73-77.
3.
AcharyaGCruz CarrerasMTRiceTW. 5-FU-induced leukoencephalopathy with reversible lesion of splenium of corpus callosum in a patient with colorectal cancer. BMJ Case Rep. 2017;2017.
4.
MorrisonGBBastianADela RosaTDiasioRBTakimotoCH. Dihydropyrimidine dehydrogenase deficiency: a pharmacogenetic defect causing severe adverse reactions to 5-fluorouracil-based chemotherapy. Oncol Nurs Forum. 1997;24(1):83-88.
5.
TakimotoCHLuZHZhangR, et al.Severe neurotoxicity following 5-fluorouracil-based chemotherapy in a patient with dihydropyrimidine dehydrogenase deficiency. Clin Cancer Res Mar. 1996;2(3):477-481.
6.
AkitakeRMiyamotoSNakamuraF, et al.Early detection of 5-FU-induced acute leukoencephalopathy on diffusion-weighted MRI. Jpn J Clin Oncol Jan. 2011;41(1):121-124.
7.
YehKHChengAL. High-dose 5-fluorouracil infusional therapy is associated with hyperammonaemia, lactic acidosis and encephalopathy. Br J Cancer. 1997;75(3):464-465.
8.
HeggieGDSommadossiJPCrossDSHusterWJDiasioRB. Clinical pharmacokinetics of 5-fluorouracil and its metabolites in plasma, urine, and bile. Cancer Res. Apr 15. 1987;47(8):2203-2206.
9.
IchikawaWTakahashiTSutoKSasakiYHirayamaR. Orotate phosphoribosyltransferase gene polymorphism predicts toxicity in patients treated with bolus 5-fluorouracil regimen. Clin Cancer Res Jul. 2006;12(13):3928-3934.
10.
WangBWalshSJSaifMW. Pancytopenia and severe gastrointestinal toxicities associated with 5-fluorouracil in a patient with thymidylate synthase (TYMS) polymorphism. Cureus. Sep. 2016;8(9):e798.
11.
DanenbergPVGustavssonBJohnstonP, et al.Folates as adjuvants to anticancer agents: chemical rationale and mechanism of action. Crit Rev Oncol Hematol. 2016;106:118-131.
12.
MaWWSaifMWEl-RayesBF, et al.Emergency use of uridine triacetate for the prevention and treatment of life-threatening 5-fluorouracil and capecitabine toxicity. Cancer. 2017;123(2):345-356.
13.
IsonGBeaverJAMcGuinnWDJr., et al.FDA approval: uridine triacetate for the treatment of patients following fluorouracil or capecitabine overdose or exhibiting early-onset severe toxicities following administration of these drugs. Clin Cancer Res. 2016;22(18):4545-4549.