Racial and ethnic differences in capecitabine toxicity in patients with gastrointestinal tract cancers

Abstract

Background Capecitabine is used as a first-line treatment for gastrointestinal (GI) tract cancers. Common toxicities of capecitabine include diarrhea and hand-foot syndrome, which frequently require dose reduction, interruption, or discontinuation. While racial and ethnic differences in capecitabine toxicities have been suggested, they have not been evaluated in a diverse “real-world” setting. We examined differences in capecitabine-related toxicities in different racial and ethnic populations. Methods The electronic medical records of patients receiving first-line capecitabine-containing regimens for GI malignancies were reviewed. Patients on irinotecan-containing regimens or radiation were excluded because of overlapping toxicities. Multiple logistic regression models were used to test the association between race or ethnicity and capecitabine toxicities while adjusting for other demographic characteristics. Results One hundred twenty-five patients diagnosed with colon (N=76, 60.8%), rectal (N=22, 17.6%), gastric (N=16, 12.8%), or other GI cancers (N=11, 8.8%) were included. In logistic regression analysis, diarrhea occurrence was significantly lower in the African-American/non-Hispanic (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.08-0.75; P=0.01) compared to Caucasian non-Hispanic population. The occurrence of dose-reduction was significantly higher in the African-American/non-Hispanic population (OR 5.83, 95%CI 1.49-22.80; P=0.01) and in the Caucasian/Hispanic population (OR 4.49, 95%CI 1.09-18.42; P=0.03) compared to Caucasian non-Hispanic population. Conclusions We have identified racial and ethnic differences in the incidence of capecitabine toxicities, which may help clinicians counsel patients with GI malignancies on capecitabine. There is a need for prospective studies to confirm our findings and to understand the relationship between the incidence of toxicities and dose reductions or discontinuation.

Racial differences in longitudinal toxicities of anticancer agents in early phase cancer clinical trials

“…The incidence of chemotherapy‐induced diarrhea associated with modulated FU regimens, single‐agent Irinotecan, and the combination of FU plus Irinotecan has been reported elsewhere to be as high as 50%–80% of treated patients, and ≥ 30% of patients may experience grade 3–5 diarrhea 23 . Racial differences in diarrhea have been reported in several studies of fluoropyrimidines in gastrointestinal cancers 9,24 . These findings are concordant with our results that among SOC gastrointestinal disorders, diarrhea was about 20% less frequent in Black people than in others.…”

“…23 Racial differences in diarrhea have been reported in several studies of fluoropyrimidines in gastrointestinal cancers. 9,24 These findings are concordant with our results that among SOC gastrointestinal disorders, diarrhea was about 20% less frequent in Black people than in others. The potential reasons for these differences were variations among races in terms of pharmacokinetics and pharmacodynamics and resulting metabolites; however, the exact causes are not clear.…”

Hand-Foot Syndrome in Cancer Patients on Capecitabine: Examining Prevalence, Impacts, and Associated Risk Factors at a Cancer Centre in Malaysia

“…Furthermore, studies have shown racial and ethnic differences in chemotherapy toxicities [31,32]. For example, a study reported higher dose reductions due to capecitabine side effects in African Americans and Hispanics [31]. Sarawak has a multiracial population comprising predominantly Ibans, Chinese, and Malays.…”

Hand-Foot Syndrome Presentation Post-Capecitabine Treatment in a Black Patient

“…In this report, the symptoms aligned with this new proposed grading system in which our patient demonstrated hyperpigmentation of palms and soles (grade 1 HFS) as opposed to the previous grading system looking for presence of dermatitis or erythema without pain [ 5 , 9 ]. It is also significant to note that one retrospective study conducted by Brazelton A et al concluded that Black patients had higher success with chemotherapeutic dose reductions as a modem for HFS treatment compared to non-Hispanic Caucasian patients [ 10 ]. Therefore, early diagnosis of grade 0 or grade 1 severity HFS may allow prompt and safer treatment modification.…”