Abstract | PURPOSE/OBJECTIVES: DATA SOURCES: Published articles, abstracts, and conference proceedings. DATA SYNTHESIS: Genetic deficiencies in DPD, the rate-limiting enzyme responsible for 5-FU catabolism, may occur in 3% or more of patients with cancer putting them at increased risk for unusually severe adverse reactions (e.g., diarrhea, stomatitis, mucositis, myelosuppression, neurotoxicity) to standard doses of 5-FU. Diagnosis of DPD deficiency must be confirmed by specialized laboratory tests. The principle treatment for DPD-deficient patients with severe acute 5-FU reactions is supportive care; however, the administration of thymidine potentially may reverse severe 5-FU-induced neurologic symptoms such as encephalopathy and coma. CONCLUSIONS: Early recognition of this serious pharmacogenetic syndrome may allow for the modification of future chemotherapy, thus avoiding further life-threatening toxicities. IMPLICATIONS FOR NURSING PRACTICE: Nurses must understand the pharmacology, mechanism of action, clinical presentation, potentially lethal risks, and traumatic psychosocial stresses experienced by DPD-deficient patients with cancer receiving 5-FU therapy in order to develop timely interventions and alternative plans of care.
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Authors | G B Morrison, A Bastian, T Dela Rosa, R B Diasio, C H Takimoto |
Journal | Oncology nursing forum
(Oncol Nurs Forum)
1997 Jan-Feb
Vol. 24
Issue 1
Pg. 83-8
ISSN: 0190-535X [Print] United States |
PMID | 9007910
(Publication Type: Case Reports, Journal Article, Review)
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Chemical References |
- Antimetabolites, Antineoplastic
- Oxidoreductases
- Dihydrouracil Dehydrogenase (NADP)
- Fluorouracil
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Topics |
- Adult
- Antimetabolites, Antineoplastic
(adverse effects, metabolism)
- Carcinoma, Hepatocellular
(drug therapy, secondary)
- Dihydrouracil Dehydrogenase (NADP)
- Female
- Fluorouracil
(adverse effects, metabolism)
- Humans
- Liver Neoplasms
(drug therapy, pathology)
- Male
- Metabolism, Inborn Errors
(complications)
- Middle Aged
- Neoplasms
(drug therapy)
- Oxidoreductases
(deficiency)
- Pleural Neoplasms
(drug therapy, secondary)
- Severity of Illness Index
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