Reactions 1404 - 2 Jun 2012

SAntineoplastics

Various toxicities: case reportA boy in his teens [age not clearly stated], who had

recurrent medulloblastoma, developed hearing loss andsymptoms considered to be principally related toarachnoiditis during treatment with intrathecal cytarabine.He also received metronomic therapy with thalidomide,celecoxib and etoposide, and developed events includingneutropenia.

The boy had been diagnosed with medulloblastoma at 14years of age, which recurred as intraspinal metastases33 months after first diagnosis (18 months after an initial15-month therapy period). The recurrence was treated withintrathecal cytarabine [DepoCyte; liposomal cytarabine]50mg, which was initially given every other week, and latergiven monthly. He received a total of 13 doses of cytarabineover 18 months, for a cumulative dose of 650mg. Withindays of his first cycle, the boy developed headache, chestpain, ataxia and limb numbness. The symptoms improvedwith steroid therapy, but recurred one week after hisseventh injection. At that time, he also developed hearingloss, slurred speech, and chest pain. He was foundsomnolent after falling on a hard floor. He was hospitalisedwith fever, neutropenia and elevated C-reactive proteinlevels.

The boy received antibiotics and dexamethasone, andetoposide was withheld. He recovered, apart from apersistent high-frequency hearing deficit for which, at lastfollow-up, he still required a hearing aid.

Three months later, cytarabine was restarted. The boyhad two further episodes involving headache, anxiety,confusion, paraesthesia, and slurring of speech [duration oftreatment to reaction onsets not stated]. On bothoccasions, his symptoms resolved with dexamethasone.Another two episodes occurred 10 weeks and 9 monthsafter his last dose of cytarabine, with similar symptoms andsomnolence; symptom resolution occurred after a day.Antiepileptic medication was given for a short time, butwithdrawn as he had no further episodes.

Two weeks after the beginning of cytarabine therapy,metronomic oral treatment with thalidomide, celecoxiband etoposide was also started. The boy’s highest doseswere thalidomide 3 mg/kg, etoposide 50 mg/m2, andcelecoxib 430 mg/m2. He received dose reductions afterdeveloping neutropenia up to grade IV followed by fatigue,sinusitis and mucositis [duration of treatment to reactiononsets and outcomes not stated]. Etoposide was withheldtwice for a few weeks, then later withdrawn; for the final8 months he had been receiving 25 mg/day on alternatedays. At last follow-up he was still receiving thalidomide50 mg/day and celecoxib 100 mg/day.

Author comment: "The side effects caused by theintrathecal therapy were assumed to be related mainly tochemical arachnoiditis."Nygaard R, et al. Treatment for recurrent medulloblastoma with intrathecalliposomal cytarabine and systemic metronomic combination therapy. Anti-CancerDrugs 23: 342-346, No. 3, Mar 2012. Available from: URL: http://dx.doi.org/10.1097/cad.0b013e32834ee315 - Norway 803071156

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Reactions 2 Jun 2012 No. 14040114-9954/10/1404-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved