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.

1

Reactions 18 Aug 2012 No. 14150114-9954/10/1415-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved