Reactions 1337 - 5 Feb 2011

SDexamethasone/docetaxel/estramustine

Reduced food intake and pellagra in elderlypatients: 2 case reports

Two patients experienced reduced food intake andpellagra during treatment with dexamethasone, docetaxeland estramustine for hormone-refractory prostate cancer.

An 81-year-old man started treatment with a 21-daycourse of combined chemotherapy. He received adocetaxel infusion 25 mg/m2 [route not clearly stated]once a week for two consecutive weeks (days 1 and 8), oralestramustine 560 mg/day during days 1–3 and days 8–10,and oral dexamethasone 1mg every day. At the time oftreatment initiation he weighed 53.4kg. After the start ofchemotherapy, in mid-October 2007, he developed nauseaand anorexia at around the time of the 3 day docetaxel andestramustine administration period [time to reaction onsetnot clearly stated]. He started to lose weight at thebeginning of November and was almost unable to eat bythe end of the month. Day 8 of his fourth course wasperformed on 26 November; the following day hedeveloped an eruption on his face and back of his hands,generalised fatigue, eye discharge and loss of appetite. Hewas unable to eat on 3 December and he was admitted.Examination revealed a brownish erythema on his eyelids,cheeks, neck and back his hands with skin proliferation. Hisbody weight was 48.7kg. Laboratory findings were notablefor a slightly elevated inflammatory response and mildanaemia and liver dysfunction. Pellagra was diagnosed onadmission day 4 and treatment with niacin was initiated.From day 6 he was able to eat more, and his erythemaimproved on day 12. His niacin dosage was tapered. Hissymptoms resolved and he was discharged on day 20.From mid-January 2008, he again experienced a loss inappetite and generalised fatigue. His overall conditiondeteriorated and he was admitted. Imaging revealedgallstones, and marked liver and renal impairment wereevident on laboratory analysis. He developed multipleorgan failure and died 2 days after admission.

An 80-year-old man started combined chemotherapywith dexamethasone, docetaxel, and estramustine [dosagesand routes not stated] following a rise in his prostatespecific antigen (PSA) level, noted on 20 July 2007. Hisbody weight was 66kg at this time. By September his foodintake was decreased and had approximately halved bymid-November [time to reaction onset not clearly stated].He received his eighth chemotherapy course on26 December. On 30 December, his eyelids reddened andhis body weight was 60kg. On 4 January 2008 hedeveloped peeling of the nails, facial flushing, skin erosionof the backs of his hands and limb oedema; pellagra wasdiagnosed and chemotherapy was withdrawn immediately.Laboratory analysis revealed slight anaemia. Niacin wasinitiated and on day 4 of treatment his symptomsimproved. On day 41 the facial flushing and erythema onthe backs of his hands had resolved. Niacin was withdrawnon day 48, and his PSA level was 0.2 ng/mL. In June 2009,he was receiving dexamethasone 1 mg/day, and remainedunder observation.

Author comment: We think that the cause was thereduced food intake which was caused by the chemotherapy.However, we cannot rule out the possibility of docetaxellowering tryptophan metabolism, causing the onset ofpellagra.Yokomizo Y, et al. Two cases of pellagra associated with chemotherapy ofdocetaxel, estramustine, dexamethasone. Hinyokika Kiyo 56: 585-8, No. 10, Oct2010 [Japanese; summarised from a translation] - Japan 803048980

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Reactions 5 Feb 2011 No. 13370114-9954/10/1337-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved