C115
Should all patients receiving capecitabine be screened for hypertrigylceridaemia? A prospective audit of incidence and severity
Caroline Michie1, Maria Sakala1, Iain Rivans1, Mark Strachan2, Sally Clive1
1Edinburgh Cancer Centre, Western General Hospital, UK, 2Western General Hospital, Edinburgh, UK
Background
Several antineoplastic agents are known to raise serum triglycerides. Capecitabine has been reported to induce significant hypertriglyceridaemia in individual case reports. In our centre, a number of patients receiving capecitabine were found to have highly raised serum triglycerides, putting them in the Very High Risk category for developing potentially life-threatening acute pancreatitis.
Aim
To ascertain whether routine triglyceride screening should be considered for patients on capecitabine, or whether particular high risk groups could be identified.
Method
We performed a 17 month prospective audit to investigate the incidence, duration and severity of capecitabine-induced hypertriglyceridaemia. Ethical approval was obtained, a management protocol formulated, all involved staff briefed, and appropriate patient and GP literature produced. Fasting blood lipids and glucose were checked before starting capecitabine, midway through treatment, and at the final cycle. Demographic and clinical data was collected on all patients with triglycerides >5mmol/l. These patients were treated and followed up for a minimum of 3 months following completion of capecitabine.
Results
All patients receiving capecitabine for gastro-intestinal cancer at the Edinburgh Cancer Centre between January 2008 and May 2009 were included. 6 patients (2 diabetic, one with known hyperlipidaemia on statin therapy), developed clinically significant hypertriglyceridaemia requiring fenofibrate drug therapy. One patient developed cerebral infarction, felt to be potentially related to hypertriglyceridaemia. There were no cases of acute pancreatitis. Follow-up demonstrated that serum triglycerides returned to normal with appropriate treatment in each case.
Conclusion
This is the first prospective study evaluating serum triglycerides with routine capecitabine therapy. Capecitabine is associated with hypertriglyceridaemia, which can be medically serious, but is not seen frequently enough to justify routine screening during treatment. Pre-existing diabetes or hyperlipidaemia may increase the risk. It is important that oncology teams are aware of this unusual but important side-effect.
