Maarten J. Deenen, PharmD; Wim E. Terpstra, MD, PhD; Annemieke Cats, MD, PhD; Henk Boot, MD, PhD; Jan H.M. Schellens, MD, PhD
Potential Conflicts of Interest: None disclosed.
Deenen MJ, Terpstra WE, Cats A, Boot H, Schellens JH. Standard-Dose Tegafur Combined With Uracil Is Not Safe Treatment After Severe Toxicity From 5-Fluorouracil or Capecitabine. Ann Intern Med. 2010;153:767-768. doi: 10.7326/0003-4819-153-11-201012070-00023
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Published: Ann Intern Med. 2010;153(11):767-768.
Background: The most frequently prescribed anticancer drugs are the fluoropyrimidines, which include 5-fluorouracil (5-FU). Most patients tolerate fluoropyrimidines well, but about 10% develop severe, potentially life-threatening complications. The most important cause of these complications is a deficiency of dihydropyrimidine dehydrogenase (DPD), the primary enzyme that detoxifies fluoropyrimidines. Fluoropyrimidines are often combined with a compound that inhibits DPD and creates an artificial DPD deficiency, which reduces interpatient variability in tolerance of the fluoropyrimidines and should allow uniform dosing for all patients. Most clinicians who prescribe chemotherapy believe that this practice is safe for DPD-deficient patients.
Objective: To describe 4 cases in which this practice was not safe for DPD-deficient patients.
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