Would you consider using capecitabine in a patient who previously had encephalopathy with 5-FU?   

I will offer my anecdote of a patient I've treated with metastatic rectal cancer. When given FOLFIRI/bev, he felt terrible 1-2 days after the 5-FU pump started. 1st cycle, bounced back with time. 2nd cycle, went to the ER and got admitted for encephalopathy, had hyperammonemia and lactic acidosis. S...

5-FU-induced encephalopathy is rare, involving 5.7% of patients treated with high-dose 5-FU chemotherapy. The mechanism of fluorouracil-induced encephalopathy is unclear, likely multifactorial. Two pathogenetic mechanisms have been postulated: 1. Dihydropyrimidine dehydrogenase (DPD) deficiency, in ...