Deceased
Mrs L
Demographics
52y, female
Coroner
Coroner Sarah Gebert
Date of death
2018-10-31
Finding date
2021-01-28
Cause of death
Neutropenic sepsis leading to multi-organ failure due to capecitabine toxicity
AI-generated summary
Mrs L, a 52-year-old woman with T2N0M0 rectal cancer, died from neutropenic sepsis and multi-organ failure secondary to severe capecitabine toxicity on 31 October 2018. She commenced neoadjuvant chemotherapy with capecitabine on 17 October 2018 and developed severe mucositis, diarrhoea, and signs of toxicity by 26 October. The antidote uridine triacetate (Vistogard) was not considered until 28 October 2018, with administration delayed until 29 October (3.5 days after drug cessation; ideally within 96 hours). Key clinical lessons include: recognising early capecitabine toxicity signs, lack of pre-treatment DPD enzyme deficiency screening, delayed consideration and administration of the specific antidote, and communication failures between institutions. Earlier recognition and antidote administration would likely have improved survival. The case highlights the need for routine DPD testing before fluoropyrimidine chemotherapy and improved access to Vistogard in Australia.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.
Specialties
Error types
Drugs involved
Clinical conditions
Procedures
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