JoEllen Zembruski-Ruple began chemotherapy for squamous cell carcinoma at Memorial Sloan Kettering Cancer Center on January 29, unaware of the dangers posed by the drug capecitabine. Six days later, she experienced severe side effects, including mouth sores and swelling, leading to her first visit to urgent care, where she was diagnosed with an oral yeast infection. Despite returning in severe distress two days later, she was admitted, and tests revealed enzyme deficiency that prevented her body from processing the chemotherapy effectively. Tragically, Zembruski-Ruple entered hospice care and died from the drug’s toxic effects on March 25, 2023, after putting up a valiant fight against her illness.
Her case highlighted issues in cancer treatment protocols, particularly the lack of testing for genetic variants that could indicate a patient’s risk of severe reactions to capecitabine and similar drugs. Experts note that about 1,300 Americans die yearly from 5-FU and capecitabine toxicity, yet routine testing for enzyme deficiencies is not standardized. Despite the FDA approving an antidote in 2015, testing remains inconsistent, and costs often deter both patients and hospitals from pursuing it.
Changes in guidance and awareness around this deficiency have been slow, with advocacy groups pushing for more rigorous testing protocols. Some patients, like Emily Alimonti, have taken initiative to demand testing, resulting in safer dosing practices. Zembruski-Ruple’s legacy continues to drive conversations about patient consent and awareness regarding genetic testing, as well as the importance of personalized cancer treatment. Her friends and family remember her fondly, underscoring her vibrant personality and empathy toward others.
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