Hypertriglyceridemia and hyperglycemia induced by capecitabine: A report of two cases and review of the literature

Background Capecitabine is a tumor-activated oral fluoropyrimidine used in breast and colorectal cancer. Hypertriglyceridemia associated with this drug has rarely been reported in the literature. Methods Two patients with colorectal carcinoma who developed capecitabine-induced hypertriglyceridemia (including a patient who developed hyperglycemia concurrently) were described, treatment modalities were discussed, and the literatures were reviewed. Results The first patient, a 43-year-old man, developed hyperlipidemia and hyperglycemia after two cycles of XELOX regimen chemotherapy for colorectal cancer. His triglyceride was 2.47mmol/L (normal range 0.34-1.7mmol/L) and total cholesterol was 6.93mmol/L (normal range 3.12-5.9mmol/L), while blood glucose was abnormal (fasting blood glucose was 10.58-11.9mmol/L and 2h postprandial glucose was 14.5-17.2mmol/L) and glucose was positive in the urine(3+). The second patient, a 47-year-old woman, developed abnormalities in the lipid profile after the sixth cycle of XELOX regimen chemotherapy for colorectal cancer. Her serum triglyceride was 2.41mmol/L (normal range 0.34-1.7mmol/L), while the cholesterol level was 7.73mmol/L (normal range 3.12-5.9mmol/L). The profile of lipid improved gradually with reduced doses of capecitabine and was well restored after chemotherapy without any lipid-lowering agents. The Naranjo score for capecitabine-induced hypertriglyceridemia was 9 (definite). An analysis of the underlying pathogenic mechanisms was provided. Conclusion It is important of physicians and pharmacists to be aware of the possibility of dyslipidemia, particularly hypertriglyceridemia induced by capecitabine.