Antineoplastics
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Reactions 1344 - 26 Mar 2011 S Antineoplastics Idiopathic thrombocytopenic purpura?: case report A 50-year-old man was diagnosed with metastatic rectal cancer and developed idiopathic thrombocytopenic purpura (ITP) after neoadjuvant chemotherapy. The man underwent surgery in July 2008 and achieved a partial response after 17 courses of oxaliplatin, fluorouracil and folinic acid (mFOLFOX6) in combination with bevacizumab [dosages and routes not stated]. Further surgery was planned but, in April 2009, his platelet count dropped to 1.4 × 10 4 /µL. A bone marrow puncture and other investigations in June led to a diagnosis of ITP and a Helicobacter pylori infection. The infection was eradicated but his platelet count did not improve. He subsequently developed ascites, systemic bleeding and epistaxis. The man’s condition and platelet count temporarily improved with prednisolone 30 mg/day [route not stated], but dropped again to 5 × 10 4 /µL when the drug was tapered. He also experienced glucose intolerance due to steroid treatment [duration of treatment to reaction onset not stated]. Prednisolone was tapered and he underwent partial splenic artery embolisation, which resulted in platelet count recovery. However, chemotherapy had to be suspended for 8 months, at which time he developed multiple hepatic, pulmonary and lymph node metastases. Plans for surgery were abandoned. In January 2010, he received cetixumab, but his disease progressed. Steroid therapy was withdrawn in March as his platelet count normalised. Folinic acid, fluorouracil and irinotecan were started. He has since achieved sustained stable disease for more than 3 months. Author comment: Our first impression was that the cause of the thrombocytopenia was ITP accompanying [H. pylori] infection but influence from mFOLFOX6 + bevacizumab chemotherapy cannot be ruled out. Murata K, et al. Idiopathic thrombocytopenic purpura during chemotherapy for liver metastasis of rectal cancer. Gan to Kagaku Ryoho 37: 2605-7, No. 12, Nov 2010 [Japanese; summarised from a translation] - Japan 803051699 1 Reactions 26 Mar 2011 No. 1344 0114-9954/10/1344-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
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
