Reactions 1344 - 26 Mar 2011

SAntineoplastics

Idiopathic thrombocytopenic purpura?: casereport

A 50-year-old man was diagnosed with metastatic rectalcancer and developed idiopathic thrombocytopenicpurpura (ITP) after neoadjuvant chemotherapy.

The man underwent surgery in July 2008 and achieveda partial response after 17 courses of oxaliplatin,fluorouracil and folinic acid (mFOLFOX6) in combinationwith bevacizumab [dosages and routes not stated].Further surgery was planned but, in April 2009, his plateletcount dropped to 1.4 × 104/µL. A bone marrow punctureand other investigations in June led to a diagnosis of ITPand a Helicobacter pylori infection. The infection waseradicated but his platelet count did not improve. Hesubsequently developed ascites, systemic bleeding andepistaxis.

The man’s condition and platelet count temporarilyimproved with prednisolone 30 mg/day [route not stated],but dropped again to 5 × 104/µL when the drug wastapered. He also experienced glucose intolerance due tosteroid treatment [duration of treatment to reaction onsetnot stated]. Prednisolone was tapered and he underwentpartial splenic artery embolisation, which resulted inplatelet count recovery. However, chemotherapy had to besuspended for 8 months, at which time he developedmultiple hepatic, pulmonary and lymph node metastases.Plans for surgery were abandoned. In January 2010, hereceived cetixumab, but his disease progressed. Steroidtherapy was withdrawn in March as his platelet countnormalised. Folinic acid, fluorouracil and irinotecan werestarted. He has since achieved sustained stable disease formore than 3 months.

Author comment: Our first impression was that the causeof the thrombocytopenia was ITP accompanying [H. pylori]infection but influence from mFOLFOX6 + bevacizumabchemotherapy cannot be ruled out.Murata K, et al. Idiopathic thrombocytopenic purpura during chemotherapy forliver metastasis of rectal cancer. Gan to Kagaku Ryoho 37: 2605-7, No. 12, Nov2010 [Japanese; summarised from a translation] - Japan 803051699

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Reactions 26 Mar 2011 No. 13440114-9954/10/1344-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved