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Interaction between capecitabine and brivudin in a patient with breast cancer

Nature Reviews Clinical Oncology volume 7, pages 55–58 (2010)Cite this article

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Abstract

Background. A 66-year-old woman with metastatic mammary carcinoma, who was being treated with capecitabine, contracted a herpes zoster infection that was treated with the antiviral drug brivudin. A drug–drug interaction between brivudin and capecitabine caused medullar aplasia, serious toxic effects to the intestinal mucous membrane, hand-foot syndrome, onycholysis and dental pigmentation.

Investigations. Physical examination, blood analysis, blood cultures, chest X-ray, bone marrow aspiration and biopsy.

Diagnosis. Serious adverse event secondary to inhibition of dihydropyrimidine dehydrogenase by a drug–drug interaction between capecitabine and brivudin.

Management. Intravenous hydration, imipenem, red blood cell and platelet transfusions, filgrastim, omeprazole, care of the mouth and feet, topical anesthetics, systemic analgesics and parenteral nutrition.

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Figure 1: Bone marrow aspirate.
Figure 2: Bone marrow biopsy sample.
Figure 3: Metabolism of capecitabine and brivudin.

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Acknowledgements

Written consent for publication was obtained from the patient. Dr Baena-Cañada and Dr Martínez were supported by a grant from the Fondo de Investigaciones Sanitarias of the Ministerio de Sanidad y Consumo, Spain (#FIS 07/0797). Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Medical Oncology Unit, Puerta del Mar University Hospital, Avenida Ana de Viya 21, 11009, Cádiz, Spain

    José M. Baena-Cañada, María J. Martínez, Obdulia García-Olmedo, Reyes Jiménez-Bárcenas & Pedro Muriel-Cueto

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  1. José M. Baena-Cañada
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Correspondence to José M. Baena-Cañada.

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Baena-Cañada, J., Martínez, M., García-Olmedo, O. et al. Interaction between capecitabine and brivudin in a patient with breast cancer. Nat Rev Clin Oncol 7, 55–58 (2010). https://doi.org/10.1038/nrclinonc.2009.185

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