Key result
Capecitabine induces severe hypertriglyceridemia peaking at ~2,700 mg/dL, managed with dose reduction.
Why the study?
Capecitabine, widely used in colorectal cancer treatment, may cause rare metabolic adverse events such as severe hypertriglyceridemia, complicating management in patients with thrombotic conditions.
Case Report (n=1)
Severe hypertriglyceridemia is a rare but significant adverse effect of capecitabine that can be successfully managed with a multidisciplinary cardio-oncology approach and lipid-lowering therapy without permanently discontinuing chemotherapy.
May warrant lipid monitoring during capecitabine in thrombophilia patients; extends rare adverse event reports but remains hypothesis-generating.
Occurrence of Colorectal Cancer (CRC) in patients with pre-existing cardiovascular or thrombotic conditions make oncologic decisions and management strategies significantly challenging. An oral chemotherapy drug widely used for CRC in adjuvant, neoadjuvant, and metastatic settings is Capecitabine, an oral fluoropyrimidine. Despite its well-established safety profile, rare metabolic adverse events, such as severe hypertriglyceridemia (HTG), may occur complicating the patient clinical course. Here, we report the case of a 50-year-old man with a longstanding history of thrombophilia (factor V Leiden mutation) who was diagnosed with stenosing sigmoid colon adenocarcinoma under oral anticoagulant treatment (vitamin K antagonists). He underwent laparoscopic left hemicolectomy followed by adjuvant capecitabine therapy. Shortly after treatment initiation, he developed marked HTG, requiring treatment discontinuation, lipid-lowering therapy, multidisciplinary reassessment, and subsequent dose adjustment. The persistent post thrombotic syndrome required continuous anticoagulation. However, oncologic treatment was completed, metabolic abnormalities were progressively controlled, and no disease recurrence was observed. Capecitabine may cause rare HTG. In high-risk patients, strict metabolic monitoring and cardio-oncologic management ensure both chemotherapy efficacy and safety.
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Bochicchio et al. (2026) conducted a case report in Colorectal cancer and severe hypertriglyceridemia (n=1). Capecitabine was evaluated on Development of severe hypertriglyceridemia. Adjuvant capecitabine induced severe hypertriglyceridemia (peak 2,744 mg/dL) in a 50-year-old man with colorectal cancer and factor V Leiden thrombophilia, managed successfully with dose reduction.
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