TORONTO, May 27 — A Singapore cancer patient arrived in the U.S. missing something very important — his fingerprints.

• Explain to interested patients that some cancer patients taking capecitabine (Xeloda) can develop hand-foot syndrome — chronic inflammation of the palms or soles of the feet.
• Note that this report concerns a man who took the drug for several years as maintenance therapy, developed the syndrome, and found his fingerprints had vanished as a result.

The man, identified only as Mr. S., was detained at airport customs for four hours until puzzled Homeland Security officials were able to verify his identity by other means, according to a letter posted online in Annals of Oncology.

The loss of fingerprints is part of a condition known as hand-foot syndrome — formally palmar-plantar erythrodysesthesia — that arises in patients taking capecitabine (Xeloda), according to the man’s doctor, Eng-Huat Tan, M.D., of the Singapore National Cancer Centre.

The syndrome causes chronic inflammation of the palms or soles of the feet and the skin can peel, bleed and develop ulcers or blisters. “This can give rise to eradication of finger prints with time,” Dr. Tan said in a statement.

The syndrome appears to be relatively common among capecitabine patients. One study, published in the Journal of Clinical Pharmacology in 2004, found that 65% of patients in clinical trials of the drug developed hand-foot syndrome, although only about 5% had a grade 3 condition.

Of those who develop the syndrome, only a few will lose their fingerprints, Dr. Tan told the Associated Press.

Mr. S., who can’t be identified for reasons of patient confidentiality, is a 62-year-old who was diagnosed with metastatic nasopharyngeal carcinoma and treated with a combination of cisplatin and 5-fluorouracil.

After a near-complete response, Dr. Tan and colleagues said, he was started in July 2005 on maintenance capecitabine at 1,750 milligrams twice daily, two weeks on, one week off.

Subsequently, Dr. Tan and his other doctors noticed that he had grade 2 hand-foot syndrome, “but as this did not affect his daily activities and function, he was kept on the same maintenance dose,” they said.

Then, last December, Mr. S. decided to visit relatives in the U.S.

When he reached U.S. immigration he was asked to provide images of the prints on his two index fingers and could not, triggering the “inconvenience,” Dr. Tan said.

Some visitors are asked to provide fingerprints at U.S. airports, which are used to detect whether the new visa applicant has a visa under a different name. “These fingerprints are also matched to a list of suspected criminals,” Dr. Tan and colleagues noted.

Mr. S. was not aware that he had lost his fingerprints before he came to the U.S.

Dr. Tan and colleagues wrote that patients “should be warned” that taking long-term capecitabine may cause problems with regards to fingerprint identification.

“It is uncertain when the onset of fingerprint loss will take place in susceptible patients who are taking capecitabine,” they said.

But more and more patients may be treated with the drug as maintenance therapy for disseminated malignancy. “These patients should prepare adequately before traveling to avert the inconvenience that Mr. S. was put through,” they wrote.

Such patients should travel with a letter from their doctor, alerting frontier officials to the possible problem.

For Mr. S., the story has a happy ending, Dr. Tan said. “My patient subsequently traveled again with a letter from us and he had fewer problems getting through,” he said.

Primary source: Annals of Oncology

Source reference:

Wong M, et al “Travel warning with capecitabine” Ann Oncol 2009; DOI: 10.1093/annonc/mdp278.

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