Una nuova rara neurotossicità correlata alla terapia combinata di capecitabina più gemcitabina: descrizione di un caso di encefalopatia posteriore reversibile

The posterior reversibile encephalopathy syndrome (PRES) is a condition characterised by reversible neurological and radiological findings that has been associated with use of chemotherapeutic and more recently novel targeted therapies. We describe one case of a 75-year-old man with PRES under treatment for metastatic carcinoma of the papilla of vater cancer because of the probable association with capecitabine plus gemcitabine combination therapy for this combination thera. Our case, to our knowledge, represents the first published report of this combination therapy. Naranjo and Jones algoritms, efficacious methods for estimating the probability of adverse drug reactions from case reports, suggest a direct casual relationship. PRES is probably a rare complication of all the chemioterapeutic fluoro-pyrimidines used in monotherapy or combination teraphy, capecitabine plus gemcitabine too, but the oncologist should take it into careful consideration, because the PRES is reversible with treatment of current hypertension or removal of the causative agent. However, failure to a quickly recognize the syndrome and discontinue the offending agent may result in profound and permanent central nervous system dysfunction or death.