Experts have raised the alarm about hundreds of cancer patients dying preventably due to a lethal side effect of chemotherapy treatment.
The complication, which affects one in 50 patients, destroys healthy cells in the body, ultimately causing multiple organ failure and, in the worst case, death.
It affects those who receive some of the most common types of chemotherapy and lack the specific enzymes needed to metabolize the drug.
Experts say there are tests to determine which unlucky patients will suffer the adverse effect, but not enough doctors are using them.
Dr. Steven Offer, a cancer researcher and associate professor of pathology at the University of Iowa Carver College of Medicine, said CBC News: ‘One thing that is striking is that these patients are dying because of their treatment… and not necessarily because the cancer has progressed.’
Carol Rosen, 70, died after taking a regular dose of the chemotherapy pill capecitabine.
They have also urged public health authorities to provide clear warning labels on medications.
Dr. Daniel Hertz, a pharmacist and associate professor at the University of Michigan School of Pharmacy, said KFF Health News: “The FDA has a responsibility to ensure that drugs are used safely and effectively.”
Not doing so, he said, “is an abdication of responsibility.”
One patient who suffered the devastating complication is Carol Rosen, a 70-year-old retired teacher from Massachusetts, who began taking chemotherapy pills for metastatic breast cancer in January 2021.
In the weeks that followed, he suffered severe diarrhea, nausea, and mouth sores that prevented him from eating, drinking, and speaking.
The skin fell off his body and his kidneys and liver stopped working.
“Your body is burning from the inside out,” said Rosen’s daughter, Lindsay Murray. KFF News.
Rosen was taking capecitabine, the pill form of chemotherapy known to cause the problem and taken by more than 275,000 cancer patients across the United States.
Instead of killing her cancer, capecitabine attacked surrounding organs until she finally died, making her one of hundreds of patients who each year lose their lives to what is supposed to be life-saving chemotherapy.
Another type of chemotherapy known to cause equally serious complications in those lacking specific enzymes is fluorouracil (also commonly known as 5FU).
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A report published by BMJ Oncology estimates that a record two million Americans will be diagnosed with cancer this year. About half of them will receive chemotherapy or radiation, according to the CDC.
Chemotherapy is a drug treatment intended to kill fast-growing cells, such as cancer cells.
There are several different drug options in chemotherapy, and the specific one that is prescribed to a patient depends on their form of cancer, its aggressiveness, and other factors, such as preexisting conditions.
However, while the drug is intended to kill malignant cells, its main risk is that it can also destroy the healthy cells that surround them, such as blood cells and hair follicles.
According to the American Cancer Society (ACS), this can cause side effects such as fatigue, hair loss, easy bruising, anemia, nausea, vomiting, appetite changes, weight changes, skin and nail changes, difficulty concentrating, bladder problems and mood swings. and fertility problems.
But these complications can be especially deadly if a patient has an extremely toxic reaction to certain chemotherapy drugs or is given excessively high doses.
This can cause dangerous symptoms such as extremely slow heart rate, heart attack, seizures, painful urination, slow breathing, severe pain, nausea, vomiting, diarrhea, high fever, heavy bleeding, and coma.
In the UK, it is now recommended that doctors test for genetic predisposition to chemotherapy complications, after cases such as Keith Gadd’s (pictured) came to light. The 73-year-old farmer had started taking capecitabine in 2018 and after five days of using the drug his health deteriorated.
“Chemotherapy is designed to kill cells under the premise that cancer cells divide and grow faster and are more susceptible to chemotherapy than healthy cells,” Dr. Hertz told DailyMail.com.
“If a patient overdoses, there will be too much chemotherapy in their body for too long, leading to the death of non-cancerous cells and overt clinical toxicity as individual organs die.”
Recent research estimates that complications from chemotherapy kill about 1 in every 1,000 patients, which equates to hundreds a year.
And up to one in 50 chemotherapy patients becomes seriously ill or hospitalized.
Most people with fatal reactions are thought to suffer from a genetic problem that leads to a deficiency of certain enzymes in the liver that can metabolize chemotherapy.
Researchers have focused on a deficiency of an enzyme, called dihydropyrimidine dehydrogenase (or DPD), which is thought to affect up to eight percent of the population.
Some scientists refer to this deadly complication as a chemotherapy “overdose,” since deficiency causes the drugs to stay in the body longer before being excreted.
“In terms of fluoropyrimidines (e.g., 5-fluoruracil and capecitabine), giving a standard dose to a DPD-deficient patient would constitute an overdose and typically causes severe toxicity and, in some unfortunate cases, results in death,” stated Dr. Hertz.
“DPD deficiency is the most common cause of overdose from fluoropyrimidine chemotherapy.”
Blood draw and cheek swab tests can detect DPD deficiency and genetic risk factors, and results are usually available within a week. This allows doctors to quickly change medications or reduce the dose.
However, a 2022 survey in the magazine JCO Oncology Practice found that only three percent of oncologists routinely order this test before giving the drug to patients.
This could be because the National Comprehensive Cancer Network, which issues guidelines for cancer treatment in the US, does not recommend preventive testing.
The FDA added warnings about the potentially lethal risks of 5-FU to the drug’s label on March 21, although it does not require testing by doctors.
However, drug authorities in the United Kingdom and elsewhere in Europe began recommending testing in 2020.
Another patient suffering the wrath of DPD deficiency is Dr. Anil Kapoor, a urologist from Canada.
In January 2023, Dr. Kapoor was treated with his first intravenous dose of fluorouracil (5-FU), a chemotherapy nearly identical to capecitabine, before succumbing to an overdose.
Dr. Amil Kapoor, a 58-year-old Canadian urologist, died three weeks after receiving a single dose of chemotherapy for stage four colon cancer.
The 58-year-old had been diagnosed with stage four colon cancer just three weeks earlier, and tests carried out after his death showed he had a genetic variant that made 5-FU toxic to him.
‘He started vomiting and feeling very nauseous. And within 24 hours she had swelling in her mouth and throat,” said her brother, emergency room physician Dr. Scott Kapoor. go in public.
“I couldn’t eat or drink anything and I also had severe diarrhea.”
Dr Kapoor’s son Akshay told Go Public: “Honestly, it was a cruel rollercoaster of emotions. I feel like we were robbed of our time together.”
Seven months after his brother’s death, Scott told KFF Health News that he met a woman who had lost her husband after he took a single dose of 5-FU at age 77.
The man was Judge Gary Markwell of Ball Ground, Georgia, who died in September 2022. His obituary states that his death was due to a “severe reaction to oral chemotherapy.”
In 2015, the FDA approved uridine triacetate, the first drug to reverse 5-FU or capecitabine overdoses in adults and children.
The drug is administered orally and is intended to block cell damage caused by chemotherapy.
Although it can be taken up to four days after giving chemotherapy, the manufacturers recommended using it as soon as an overdose is suspected.