2
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Kelkar N, Wang J. Association of Tumor Lysis Syndrome and Metastatic Melanoma. Cureus 2021; 13:e18108. [PMID: 34692319 PMCID: PMC8525684 DOI: 10.7759/cureus.18108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Tumor lysis syndrome (TLS) is a known oncologic emergency characterized by severe metabolic derangements. TLS has been well documented in patients with hematologic malignancies, but rarely with metastatic melanoma. The objective of this study was to investigate the clinical characteristics and outcomes of TLS with metastatic melanoma. Methods Retrospective literature review and analysis. Results Eighteen cases of TLS were identified with metastatic melanoma from published literature. The median age of patients was 63 years (36-79 years). All patients have stage IV disease. Seven cases (39%) of TLS were associated with multiple treatment regimes, including nivolumab (22%), ipilimumab (16%), and dacarbazine (22%). The time from treatment to diagnosis was 3.5 days (8 hours-21 days) in treatment-related TLS. Three cases (17%) were due to spontaneous TLS. The majority of cases have a high tumor burden (77.5%) and liver metastasis (83%). Seven cases were treated with rasburicase (39%). The mortality rate was 100% for the patients with spontaneous TLS and 73% for patients with treatment-related TLS. Three cases utilized traditional chemotherapy and the six most recent cases of treatment-associated TLS utilized immunotherapy and targeted therapy. Conclusion TLS in metastatic melanoma, due to either spontaneous or treatment-related causes, is associated with a very high mortality rate. This study highlights the importance of awareness, early intervention, and risk assessment of this underdiagnosed emergency.
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Affiliation(s)
- Neil Kelkar
- Oncology, University of Arizona College of Medicine - Phoenix, Phoneix, USA
| | - Jue Wang
- Genitourinary Oncology, Dignity Health Cancer Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA.,Genitourinary Oncology, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
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3
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Wang L, Li X, Zhao B, Mei D, Jiang J, Duan J. Immune Checkpoint Inhibitor-Associated Tumor Lysis Syndrome: A Real-World Pharmacovigilance Study. Front Pharmacol 2021; 12:679207. [PMID: 34630077 PMCID: PMC8495237 DOI: 10.3389/fphar.2021.679207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/04/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Immune checkpoint inhibitors (ICIs) have substantially improved the clinical outcomes of various malignancies. However, the adverse event of tumor lysis syndrome (TLS) has not been included in the National Comprehensive Cancer Network guidelines or drug inserts. In this study, we aimed to establish the relationship between ICI therapies and TLS events using data from a real-world pharmacovigilance database. Methods: The MedDRA terms of TLS and both generic and brand names of ICIs were retrieved from the FDA Adverse Event Reporting System. Four frequentist algorithms were employed to confirm the association between the TLS and the ICI regimens, involving anti-cytotoxic T lymphocyte antigen-4 (anti-CTLA-4), anti–programmed death receptor-1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1), and anti-(CTLA-4 + PD-1). A descriptive and statistical analysis was performed according to the case information. Results: One hundred sixty-four TLS cases, where patients underwent anti-CTLA-4 (n = 14), anti-(PD-1)/(PD-L1) (n = 113), or anti-(CTLA-4 + PD-1) (n = 37) therapies, were collected between the first quarter of 2004 and the fourth quarter of 2020. The most coverage-reporting year, age-group, sex, reporter, region, country, and indication were 2020 (n = 62), 60–74 years (n = 65), males (n = 105), physician (n = 66), Asia (n = 80), Japan (n = 67), and lung and thymus malignancies (n = 40), respectively. The median TLS onset time associated with anti-CTLA-4, anti-(PD-1)/(PD-L1), and anti-(CTLA-4 + PD-1) therapies was 6 (IQR: 2–39.5), 9 (IQR: 2–40), and 20 (IQR: 7.5–37.75) days, respectively. Mortality distribution of 71 reported death outcomes among three groups was statistically significant. All four algorithm signal values of anti-(CTLA-4 + PD-1) were higher than those of anti-CTLA-4 and anti-(PD-1)/(PD-L1). Conclusion: Elderly male patients with lung and thymus malignancies are frequently predisposed to TLS. ICI therapies could induce TLS in both solid and hematological malignancies. The rapid onset time and poor outcomes of patients prompt caution from health-care professionals.
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Affiliation(s)
- Li Wang
- Department of Pharmacy, Peking University International Hospital, Beijing, China
| | - Xiaolin Li
- Department of Pharmacy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Zhao
- Department of Pharmacy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dan Mei
- Department of Pharmacy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiandong Jiang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingli Duan
- Department of Pharmacy, Peking University International Hospital, Beijing, China
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4
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Konishi R, Ishitsuka Y, Imai H, Inoue S, Nakamura Y, Okiyama N, Oshika T, Hiraoka T, Fujisawa Y. Tumor lysis syndrome and collateral immune activation in dual checkpoint blockade. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2021. [DOI: 10.1002/cia2.12148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Risa Konishi
- Department of Dermatology Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Yosuke Ishitsuka
- Department of Dermatology Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Hidemi Imai
- Department of Dermatology Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Sae Inoue
- Department of Dermatology Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Yoshiyuki Nakamura
- Department of Dermatology Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Naoko Okiyama
- Department of Dermatology Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Tetsuro Oshika
- Department of Ophthalmology Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Takahiro Hiraoka
- Department of Ophthalmology Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Yasuhiro Fujisawa
- Department of Dermatology Faculty of Medicine University of Tsukuba Ibaraki Japan
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6
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Magara A, Kato H, Oda T, Nakamura M, Komatsu H, Morita A. Tumor lysis syndrome associated with nivolumab plus ipilimumab combination therapy in a melanoma patient. J Dermatol 2020; 47:e411-e412. [PMID: 32856327 DOI: 10.1111/1346-8138.15547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Azusa Magara
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takao Oda
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hirokazu Komatsu
- Division of Clinical Oncology, Nagoya City University Hospital, Nagoya, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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7
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Sugimoto S, Terashima T, Yamashita T, Iida N, Kitahara M, Hodo Y, Shimakami T, Takatori H, Arai K, Kawaguchi K, Kitamura K, Yamashita T, Sakai Y, Shirota Y, Sato K, Mizukoshi E, Honda M, Harada K, Kaneko S. Tumor lysis syndrome in a patient with metastatic melanoma treated with nivolumab. Clin J Gastroenterol 2020; 13:935-939. [PMID: 32594423 DOI: 10.1007/s12328-020-01164-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/14/2020] [Indexed: 12/14/2022]
Abstract
A 79-year-old man with metastatic melanoma of the right maxillary sinus and multiple liver metastases received a single dose of nivolumab. Eight days later, he experienced impaired consciousness, accompanied by abnormal laboratory and electrocardiographic findings. He was therefore diagnosed with tumor lysis syndrome (TLS). Laboratory and electrocardiographic findings improved immediately after continuous hemodiafiltration; however, he died 22 days after receiving nivolumab. Autopsy revealed massive tumor necrosis in the liver. There are few case reports of TLS associated with immune checkpoint inhibitors, indicating that we should be prepared to manage especially in a patient with liver involvement of high tumor burden.
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Affiliation(s)
- Saiho Sugimoto
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takeshi Terashima
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tatsuya Yamashita
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Noriho Iida
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Masaaki Kitahara
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yuji Hodo
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Ishikawa, 920-0353, Japan
| | - Tetsuro Shimakami
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hajime Takatori
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kuniaki Arai
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazunori Kawaguchi
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuya Kitamura
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Taro Yamashita
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yoshio Sakai
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yukihiro Shirota
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Ishikawa, 920-0353, Japan
| | - Katsuaki Sato
- Department of Pathology, Noto General Hospital, Nanao, Ishikawa, 926-0816, Japan
| | - Eishiro Mizukoshi
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Masao Honda
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kenichi Harada
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, 920-8640, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
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8
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Fa'ak F, Vanegas D, Osei KM. A Case Report of Atezolizumab Induced Tumor Lysis Syndrome. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:785-789. [PMID: 31160547 PMCID: PMC6561135 DOI: 10.12659/ajcr.915351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patient: Female, 67 Final Diagnosis: Atezolizumab induced tumor lysis syndrome Symptoms: Generalized weakness • hematuria • nausea • vomiting Medication: Atezolizumab Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
- Faisal Fa'ak
- Department of Internal Medicine, Piedmont Athens Regional Medical Center, Athens, GA, USA
| | - Diego Vanegas
- Department of Internal Medicine, Piedmont Athens Regional Medical Center, Athens, GA, USA
| | - Kofi M Osei
- Department of Internal Medicine, Piedmont Athens Regional Medical Center, Athens, GA, USA
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9
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Pham CM, Kalyam K, Smith BT, Floyd J, Holds JB. Acute Angle Closure Precipitated by Hemorrhage and Necrosis of a Large Uveal Melanoma in the Setting of Systemic Immunomodulatory Therapy. Ocul Oncol Pathol 2018; 3:254-258. [PMID: 29344476 DOI: 10.1159/000460255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 01/31/2017] [Indexed: 02/05/2023] Open
Abstract
Management of nonmetastatic uveal melanoma has been well studied and a large body of work has been published by the Collaborative Ocular Melanoma Study (amongst many others). Management of uveal melanoma that is found to be metastatic upon initial diagnosis, however, is less well defined. We report an interesting case of acute angle closure caused by necrosis and hemorrhage into a large uveal melanoma occurring shortly after initiation of immunomodulatory therapy with ipilimumab and nivolumab for metastatic disease. The use of these immunomodulatory agents in the setting of metastatic uveal melanoma is not well studied, and our case illustrates the importance of interdisciplinary communication in order to best decide the timing of surgical and systemic medical management to optimize outcomes and minimize morbidity.
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Affiliation(s)
- Chau M Pham
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine
| | - Krishna Kalyam
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine
| | | | - Justin Floyd
- Cancer Care Specialists of Illinois, Swansea, IL
| | - John B Holds
- Ophthalmic Plastic and Cosmetic Surgery Inc., St. Louis, MO, USA
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