Forbidden to Drive –  a New Chemotherapy Side Effect

Overview

Background:
Capecitabine is an oral antineoplastic agent classified as a pyrimidin analogue. It is widely used in different types of cancers. Unfortunately, it does not come without a cost, as the drug may have adverse effects – largely diarrhea, but also hand‑ foot syndrome and loss of fingerprints in extreme cases.

Case:
We report a case of a 47-year-old male, which had been dia­gnosed with metastatic rectal cancer and received capecitabine, developing a severe hand foot syndrome which led him to lose his fingerprints in spite of complete resolution of the syndrome after stoppage of the drug.

Conclusion:
This case highlights a rare condition that, even though not precisely a disease per se, may hinder patient‘s quality of life and must be recognised by the treating physician as an treatment related side effect.

Key words:
capecitabine –  fingers –  fluorouracil/ adverse effects –  fluorouracil/ analogs and derivatives – humans –  male – skin/drug effects

Capecitabine is an oral antineoplastic agent classified as a pyrimidin analogue. It is widely used in breast [1] and colorectal cancers [2], among others. Unfortunately, it does not come without a cost, as the drug may have adverse effects –  largely diarrhea, but also hand‑ foot syndrome [3].

More than hand‑foot syndrome, which usually gives the patient a full recovery after the drug stoppage, continous use of capecitabine may uncommonly lead to loss of fingerprints, as has been already reported [4].

We report a case of a 47‑year‑ old male, who had been diagnosed with metastatic rectal cancer in October 2013. He underwent surgery of the primary tumour to avoid local obstruction, with liver and peritoneal implants at the diagnosis. After receiving initially FOLFOX as first‑line therapy, with good clinical response, the patient developed a severe grades III/ IV peripheral neuropathy which made impossible further oxaliplatin‑based treatment.

At the time, the patient refused any intravenous therapy, so we decided to give capecitabine monotherapy as it was the only available option.

The patient used it for about eight months, starting with 2,000 mg/ m² daily. Soon, he developed hand‑foot syndrome,initially mild (grade I) but eventually evolving into moderate to severe (grade IV), which prompted several dose reductions and administration delays with limited success in diminishing the side effects.

The patient then decided to stop all medical treatment for his disease and try unconventional medicine instead. Much to our surprise, he returned six months later still in reasonable good shape, not willing to resume anti‑neoplastic therapy, but to complain that even though he had apparently fully recovered from hand‑ foot syndrome, he was not allowed to receive a driver’s license because he lacked fingerprints (Fig. 1). We wrote a letter explaining the medical reasons for that so he could get his license. By the time, his peripheral neuropathy was fairly better especially in the hands, as expected [5].

After that, he only returned a few months later when he was on the verge of liver failure and was admitted for palliative care and died.

This case highlights a rare condition that, even though not precisely a disease per se, may hinder patient’s quality of life and must be recognised by the treating physician as a treatment‑related side‑ effect.

The authors declare they have no potential conflicts of interest concerning drugs, pro­ducts, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE recommendation for biomedical papers.

Rodrigo Kraft Rovere, MD

Oncology Unit Santo Antonio Hospital

Rua Itajai 545 Blumenau, Santa Catarina CEP 89050100

Brazil

e-mail: rodrigorovere@hotmail.com

Submitted: 28. 6. 2015

Accepted: 27. 8. 2015