Background: Pemetrexed and gemcitabine are both antimetabolites drugs approved in solid tumors including non-small cell lung cancer (NSCLC). Their toxicity profile is well known. However, rare vascular side effects can occur such as vascular acrosyndromes and especially digital ischemia. The cause of this disfiguring and painful event is still controversial. Amputation is frequently required and has been described as a predictor of poor survival outcomes.

Case Presentation: This report presents two cases of vascular acrosyndrome in NSCLC cancer patients during treatment with antimetabolites (pemetrexed and gemcitabine). Patients presented severe digital ischemia having required prostacyclin analogue and chemotherapy discontinuation. In one case, symptoms improved while in the other case symptoms persisted. Both patients experienced prolonged tumor response. These findings suggest a multifactorial mechanism behind digital necrosis including an autoimmune process, which could lead to prolonged tumor control as described with immune checkpoint inhibitors.

Conclusion: Severe vascular acrosyndrome such as digital ischemia can occur in lung cancer patients treated with antimetabolites. These drugs should be used with caution in patients with predisposing factors. Prolonged tumor response may be observed when immune vascular side effects occur, but this association needs further investigations.

European Journal of Clinical Oncology Cancer poses a major challenge to development; it undermines socio-economic advances throughout the world. It is estimated that the number of patients with cancer would increase from 12.7 million in the year 2008 to 22.2 million by 2030. It is universally agreed that the condition is reaching epidemic proportions. At this time, the European Journal of Clinical Oncology is conveniently placed in the scholarly communication milieu to help counter the menace of cancer by aiding the development of novel treatment strategies, by providing novel insights into the mechanisms underlying this complex disease.

European Journal of Clinical Oncology publishes peer-reviewed original research articles, review articles, short communications, expert opinions, commentaries and letters/editorials based on open access policy. Author(s) are invited to submit their manuscripts as an e-mail attachment for fast and efficient processing. Aims & scope of the journal, key words, indexing as well as bibliographic information can be accessed at https://www.iomcworld.org/european-clinical-oncology.html

John Robert

Managing Editor
European Journal of Clinical Oncology
Mail ID: oncology@scholarlymed.com