Acute reversible toxic encephalopathy during capecitabine and oxaliplatin treatment

Abstract

Introduction Capecitabine is a fluoropyrimidine commonly used in the treatment of colorectal cancer which may cause central nervous system toxicity, namely cerebellar dysfunction. Case report We describe a 77-year-old man undergoing adjuvant treatment of colon cancer with capecitabine and oxaliplatin who presented with acute cerebellar ataxia and encephalopathy that progressed to coma. Diagnosis of toxic encephalopathy was made after the exclusion of alternative causes of neurological dysfunction and complete resolution of clinical findings with permanent discontinuation of chemotherapy. Discussion When patients with cancer develop symptoms and signs of central nervous dysfunction, metabolic and infectious causes plus tumor involvement of central nervous system must be sought. However, chemotherapy may also cause toxicity to the central nervous system. Capecitabine is no exception, although cerebellar dysfunction is rarely reported. Conclusion Although rare, capecitabine-induced encephalopathy may be severe and physicians should be aware of this possible side effect.

Transient Coma and Signs of Encephalopathy Related to 5-Fluorouracil and Carboplatin: A Case Report

“…Some studies have reported the successful treatment of 5FU-related encephalopathies with the 5FU antagonist, uridine triacetate [19,20], which might be a therapeutic option for 5FU-associated acute central nervous system toxicities with and without elevated ammonium levels, but which is not yet broadly available [21]. Encephalopathies have also been reported during treatment with the 5FU prodrug, capecitabine, implying that a switch to capecitabine might not be a safer alternative [22][23][24].…”