Antineoplastics
1
Reactions 1394 - 24 Mar 2012 S Antineoplastics Various toxicities in elderly patients: 3 case reports Three elderly men with multiple myeloma developed various toxicities while receiving treatment with antineoplastics [routes not stated]. A 78-year-old man started receiving melphalan, prednisolone and thalidomide in April 2008 [dosages not stated]. After seven cycles, he developed grade 2 peripheral neuropathy, and treatment was withdrawn. Following disease progression, he was prescribed lenalidomide and dexamethasone 16mg twice weekly. Dexamethasone was decreased to half the dose at week 2 due to hypertension and diaphoresis. After four cycles, dexamethasone was increased to 16mg twice weekly. However, he subsequently developed symptoms of axonal peripheral polyneuropathy, and dexamethasone was decreased to 8mg once weekly for the seventh cycle. After receiving clonazepam, his neuropathy resolved. At last follow-up, after 22 cycles, he had no neuropathy-related symptoms; however, after the onset of severe lower extremity muscle pain, dexamethasone was decreased to 4 mg/week. His muscle pain then improved. A 67-year-old man received melphalan, prednisolone and thalidomide [dosages not stated]. After four cycles, he developed grade 2 peripheral neuropathy. Despite a decreased thalidomide dose, neuropathy persisted. Two further cycles of melphalan with prednisone were administered, after which his neuropathy improved. After disease progression, he started receiving lenalidomide 25 mg/day on days 1–21 of a 28-day cycle and dexamethasone. His peripheral neuropathy then improved. After six cycles, treatment was withheld due to neutropenia (1.21 × 10 9 /L). Lenalidomide was subsequently restarted at 15 mg/day for 21 days after his neutrophil count increased. After 18 cycles, lenalidomide was decreased again due to response of disease markers. By the end of cycle 24, his complete blood count was normal. A 72-year-old man underwent radiotherapy of the lumbar spine and started receiving bortezomib 2.4mg on days 1, 4, 8, 11, 22, 25, 29 and 32 every 6 weeks, with melphalan 16mg [frequency not stated] and prednisolone 110mg on days 1–4. Four cycles were scheduled; however, after the second cycle, he had refractory disease. In July 2010, he was switched to lenalidomide 25mg once daily for 21 days and dexamethasone 40mg once daily for 4 days in monthly cycles. One month later, he presented to an emergency department with sudden onset diaphoresis, dyspnoea and lightheadedness. Diagnostic findings were consistent with pulmonary thromboembolism. Lenalidomide and dexamethasone were withdrawn, and he received enoxaparin sodium, amiodarone and nitroglycerin. Two months later, lenalidomide was restarted at half the previous dose, while low molecular weight heparin therapy was continued. After about 1 month, lenalidomide was reduced again to 5 mg/day. He had no further adverse effects. Joao C, et al. Advantageous use of lenalidomide in multiple myeloma: Discussion of three case studies. Current Opinion in Oncology 24 (Suppl. 2): S13-S20, No. 2, Feb 2012. Available from: URL: http:// dx.doi.org/10.1097/01.cco.0000410244.91697.5a - Portugal 803068451 1 Reactions 24 Mar 2012 No. 1394 0114-9954/10/1394-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1394 - 24 Mar 2012
SAntineoplastics
Various toxicities in elderly patients: 3 casereports
Three elderly men with multiple myeloma developedvarious toxicities while receiving treatment withantineoplastics [routes not stated].
A 78-year-old man started receiving melphalan,prednisolone and thalidomide in April 2008 [dosages notstated]. After seven cycles, he developed grade 2 peripheralneuropathy, and treatment was withdrawn. Followingdisease progression, he was prescribed lenalidomide anddexamethasone 16mg twice weekly. Dexamethasone wasdecreased to half the dose at week 2 due to hypertensionand diaphoresis. After four cycles, dexamethasone wasincreased to 16mg twice weekly. However, hesubsequently developed symptoms of axonal peripheralpolyneuropathy, and dexamethasone was decreased to8mg once weekly for the seventh cycle. After receivingclonazepam, his neuropathy resolved. At last follow-up,after 22 cycles, he had no neuropathy-related symptoms;however, after the onset of severe lower extremity musclepain, dexamethasone was decreased to 4 mg/week. Hismuscle pain then improved.
A 67-year-old man received melphalan, prednisoloneand thalidomide [dosages not stated]. After four cycles, hedeveloped grade 2 peripheral neuropathy. Despite adecreased thalidomide dose, neuropathy persisted. Twofurther cycles of melphalan with prednisone wereadministered, after which his neuropathy improved. Afterdisease progression, he started receiving lenalidomide25 mg/day on days 1–21 of a 28-day cycle anddexamethasone. His peripheral neuropathy then improved.After six cycles, treatment was withheld due to neutropenia(1.21 × 109/L). Lenalidomide was subsequently restarted at15 mg/day for 21 days after his neutrophil count increased.After 18 cycles, lenalidomide was decreased again due toresponse of disease markers. By the end of cycle 24, hiscomplete blood count was normal.
A 72-year-old man underwent radiotherapy of thelumbar spine and started receiving bortezomib 2.4mg ondays 1, 4, 8, 11, 22, 25, 29 and 32 every 6 weeks, withmelphalan 16mg [frequency not stated] and prednisolone110mg on days 1–4. Four cycles were scheduled; however,after the second cycle, he had refractory disease. In July2010, he was switched to lenalidomide 25mg once daily for21 days and dexamethasone 40mg once daily for 4 days inmonthly cycles. One month later, he presented to anemergency department with sudden onset diaphoresis,dyspnoea and lightheadedness. Diagnostic findings wereconsistent with pulmonary thromboembolism.Lenalidomide and dexamethasone were withdrawn, and hereceived enoxaparin sodium, amiodarone andnitroglycerin. Two months later, lenalidomide wasrestarted at half the previous dose, while low molecularweight heparin therapy was continued. After about1 month, lenalidomide was reduced again to 5 mg/day. Hehad no further adverse effects.Joao C, et al. Advantageous use of lenalidomide in multiple myeloma: Discussionof three case studies. Current Opinion in Oncology 24 (Suppl. 2): S13-S20, No. 2,Feb 2012. Available from: URL: http://dx.doi.org/10.1097/01.cco.0000410244.91697.5a - Portugal 803068451
1
Reactions 24 Mar 2012 No. 13940114-9954/10/1394-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
