Rare capecitabine-induced acute hypertriglyceridemia with angina: a case report and review of the literature

Capecitabine (CAP) is widely used to treat gastrointestinal and breast cancer, and is generally well tolerated. Hand-foot syndrome and gastrointestinal intolerance are the most common adverse effects. Capecitabine-induced hypertriglyceridemia (CIHT) is a very rare adverse effect and, from the reported literatures, is often neglected in clinical practice. Here, we report a case of CIHT with angina. A 58-year-old man with metastatic rectal cancer was admitted to the emergency room (ER) due to severe chest pain after treatment with CAP (Xeloda). The blood sample showed separation of blood and lipids, and the lipid profile revealed rapidly increased triglyceride and cholesterol levels. After fenofibrate therapy was administered, the patient's symptoms were relieved, and the repeat lipid test was normalized. Other causes of hyperlipidemia were carefully excluded, considering that the severe adverse effects of CAP had since abated. The earliest onset of the incidence as far as we know, the symptom of angina at the same time with CIHT, and distinct blood-lipid layer in blood sample all suggest the rarity of this case. We also concluded reports of CIHT and found that CIHT accidence was higher than our known. We genuinely hope that this case could awaken clinicians' awareness of the use of CAP.