Antineoplastics
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Reactions 1415 - 18 Aug 2012 ★ S Antineoplastics Tumour lysis syndrome with acute renal failure (first report with floxuridine and oxaliplatin): case report A 57-year-old man developed tumour lysis syndrome with acute renal failure while receiving docetaxel, floxuridine, folinic acid [leucovorin] and oxaliplatin,. The man, who had been diagnosed with gastric adenocarcinoma in late 2006, presented with metastatic liver nodules in 2011. He received chemotherapy with IV docetaxel 25 mg/m 2 over 30 minutes on days 1, 8 and 15, IV floxuridine 110 mg/kg over 24 hours on days 1, 8 and 15, IV folinic acid 500 mg/m 2 over 24 hours on days 1, 8 and 15, and IV oxaliplatin 85 mg/m 2 over 2 hours on days 1 and 15. Seven days after starting the first cycle of chemotherapy, he developed oliguria, generalised weakness, nausea and vomiting. Examination revealed a poor general condition, volume depletion with low BP, hepatomegaly, tachycardia, a respiratory rate of 20/min and a body temperature of 36.6°C. ECG revealed atrial fibrillation, while renal ultrasound revealed increased bilateral cortical echogenicity. Findings from tests included hyperkalaemia, hyperphosphataemia, hypocalcaemia, hyperuricaemia, a creatinine level of 14.98 mg/dL, a blood urea nitrogen (BUN) level of 183 mg/dL and an estimated glomerular filtration rate (eGFR) of 3 mL/min. He was diagnosed with chemotherapy-induced tumour lysis syndrome with acute renal failure. The man received volume expansion, sodium bicarbonate, calcium gluconate, insulin, dextrose and allopurinol. Laboratory tests did not improve, and he received haemodialysis over 2 weeks. Eighteen days later, his electrolyte and metabolic parameters had normalised; however, his renal function remained impaired with a creatinine level of 3.86 mg/dL, BUN of 23 mg/dL and eGFR of 16 mL/min. Author comment: "Our patient with metastatic gastric adenocarcinoma developed metabolic (hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia) and clinical (cardiac arrhythmia and acute renal failure) derangements 7 days after instituting chemotherapy, meeting CTLS diagnostic criteria [for tumour lysis syndrome]." Vodopivec DM, et al. An unusual presentation of tumor lysis syndrome in a patient with advanced gastric adenocarcinoma: Case report and literature review. Case Reports in Medicine 2012: [12 pages], No. 468452, 2012. Available from: URL: http://dx.doi.org/10.1155/2012/468452 - USA 803075585 » Editorial comment: A search of AdisBase, Embase and Medline did not reveal any previous case reports of tumour lysis syndrome associated with floxuridine or oxaliplatin. The WHO ADR database contained 5 reports of tumour lysis syndrome associated with oxaliplatin, and no reports of tumour lysis syndrome associated with floxuridine. 1 Reactions 18 Aug 2012 No. 1415 0114-9954/10/1415-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1415 - 18 Aug 2012
★ SAntineoplastics
Tumour lysis syndrome with acute renal failure(first report with floxuridine and oxaliplatin): casereport
A 57-year-old man developed tumour lysis syndromewith acute renal failure while receiving docetaxel,floxuridine, folinic acid [leucovorin] and oxaliplatin,.
The man, who had been diagnosed with gastricadenocarcinoma in late 2006, presented with metastaticliver nodules in 2011. He received chemotherapy with IVdocetaxel 25 mg/m2 over 30 minutes on days 1, 8 and 15,IV floxuridine 110 mg/kg over 24 hours on days 1, 8 and 15,IV folinic acid 500 mg/m2 over 24 hours on days 1, 8 and15, and IV oxaliplatin 85 mg/m2 over 2 hours on days 1 and15. Seven days after starting the first cycle ofchemotherapy, he developed oliguria, generalisedweakness, nausea and vomiting. Examination revealed apoor general condition, volume depletion with low BP,hepatomegaly, tachycardia, a respiratory rate of 20/min anda body temperature of 36.6°C. ECG revealed atrialfibrillation, while renal ultrasound revealed increasedbilateral cortical echogenicity. Findings from tests includedhyperkalaemia, hyperphosphataemia, hypocalcaemia,hyperuricaemia, a creatinine level of 14.98 mg/dL, a bloodurea nitrogen (BUN) level of 183 mg/dL and an estimatedglomerular filtration rate (eGFR) of 3 mL/min. He wasdiagnosed with chemotherapy-induced tumour lysissyndrome with acute renal failure.
The man received volume expansion, sodiumbicarbonate, calcium gluconate, insulin, dextrose andallopurinol. Laboratory tests did not improve, and hereceived haemodialysis over 2 weeks. Eighteen days later,his electrolyte and metabolic parameters had normalised;however, his renal function remained impaired with acreatinine level of 3.86 mg/dL, BUN of 23 mg/dL and eGFRof 16 mL/min.
Author comment: "Our patient with metastatic gastricadenocarcinoma developed metabolic (hyperkalemia,hyperuricemia, hyperphosphatemia, and hypocalcemia) andclinical (cardiac arrhythmia and acute renal failure)derangements 7 days after instituting chemotherapy, meetingCTLS diagnostic criteria [for tumour lysis syndrome]."Vodopivec DM, et al. An unusual presentation of tumor lysis syndrome in apatient with advanced gastric adenocarcinoma: Case report and literature review.Case Reports in Medicine 2012: [12 pages], No. 468452, 2012. Available from:URL: http://dx.doi.org/10.1155/2012/468452 - USA 803075585
» Editorial comment: A search of AdisBase, Embase andMedline did not reveal any previous case reports of tumourlysis syndrome associated with floxuridine or oxaliplatin. TheWHO ADR database contained 5 reports of tumour lysissyndrome associated with oxaliplatin, and no reports oftumour lysis syndrome associated with floxuridine.
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Reactions 18 Aug 2012 No. 14150114-9954/10/1415-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
