Gemcitabine-induced digital necrosis in a patient with cervical squamous cell carcinoma: case report and literature review

Abstract

Objectives: To present the case of a patient with squamous cell carcinoma of the cervix who developed distal necrosis following treatment with gemcitabine, and to perform a literature review to assess the association between the cumulative dose of gemcitabine, diagnosis, and management of this complication.

Material and methods: A 61 year old patient was treated with gemcitabine (total accumulated dose of 11,744 mg/m²) for metastatic disease at a private, nononcological, fourth level general hospital, where she was receiving outpatient management. She developed distal necrosis of the second finger on her right hand, leading to the discontinuation of gemcitabine and necessitating amputation of the affected finger. A search was conducted in Embase, Medline, and Lilacs for case reports and case series on gemcitabine induced distal necrosis. Data on dosage, diagnosis, and treatment were extracted.

Results: Fifteen case reports including 19 cases of distal necrosis were identified. The cumulative doses of gemcitabine ranged from 1,700 to 28,700 mg/m². Diagnosis was primarily clinical, supplemented by angiography and Doppler ultrasound; treatment included discontinuation of gemcitabine, initiation of vasodilators, anticoagulants, and symptomatic management.

Conclusions: It is essential to recognize vascular toxicity as a potential adverse effect of gemcitabine and to conduct appropriate risk stratification in patients with advanced cancer and multiple prior treatment lines. Increased monitoring for this adverse effect is warranted with the use of this medication.