Chemotherapy generates numerous adverse effects, but digital
ischemia is usually associated with a paraneoplastic mechanism. In addition to
thrombotic microangiopathy or hepatic or
pulmonary venoocclusive disease gemcitabine appears to induce this type of complication. This study presents two cases of digital
ischemia, which are very likely attributable to
gemcitabine. The first case involved a 56-year-old female patient with lymph node metastatic
squamous cell carcinoma, for which no primitive
tumor could be identified. This
carcinoma had been treated at a second stage with
gemcitabine at a cumulative dose of 14 390 mg. Search for etiology revealed toxic vascularitis. Response was favourable after interruption of
gemcitabine and prescription of a suitable medical treatment. The second case was a 74-year-old male patient with an infiltrating bladder urothelium
carcinoma with
lymph node metastasis. He had been treated by surgery and
chemotherapy (
gemcitabine and carboplatine).
Gemcitabine-induced arterial
thrombosis was diagnosed. Nine other cases of digital
ischemia were identified in the literature. This rare adverse effect is probably underestimated. The other reported vascular side-effects are
thrombotic microangiopathy, with an estimated occurrence of 1 per 6,000 patients and two cases of veno-occlusive disease. The pathogenic mechanisms have still not been fully elucidated. Precautions before use are necessary, especially in case of associated micro or macroangiopathy.