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Soliman A, Habibi S, Dasanu CA. Unusual stroke-like symptoms with oxaliplatin use. J Oncol Pharm Pract 2023; 29:1766-1769. [PMID: 37323007 DOI: 10.1177/10781552231181525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Oxaliplatin has become the mainstay of treatment for many cancers, but its use can be accompanied by unusual side effects. CASE REPORT We describe herein a 74-year-old patient with pancreatic cancer who developed severe motor weakness affecting lower extremities after starting treatment with oxaliplatin on three separate occasions. Our patient also experienced slurred speech, with decreased ability to phonate and word-finding difficulty. Brain imaging studies did not suggest recent brain ischemia, and the symptoms resolved within 15-20 h. MANAGEMENT AND OUTCOME Oxaliplatin had to be discontinued due to suboptimal tolerance and a short-lived clinical response. After discontinuation of oxaliplatin, she did not experience any more similar symptoms. A score of 9 on the Naranjo nomogram supported a definite causality relationship between oxaliplatin and the observed neurologic toxicity. DISCUSSION Rare reports of stroke-like events have previously been described with oxaliplatin. While the exact mechanism of these phenomena is not known, alterations in neuronal sodium channels might be involved. Clinicians, pharmacists, and patients need to be aware of these rare but important side effects of oxaliplatin. Nonetheless, work-up for a cerebrovascular accident is still warranted as hypercoagulability related to malignancy can also predispose the patients to strokes.
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Affiliation(s)
- Abram Soliman
- Department of Internal Medicine, Eisenhower Health, Rancho Mirage, CA, USA
| | - Shaghayegh Habibi
- Department of Internal Medicine, Eisenhower Health, Rancho Mirage, CA, USA
| | - Constantin A Dasanu
- Lucy Curci Cancer Center, Eisenhower Health, Rancho Mirage, CA, USA
- Department of Medical Oncology and Hematology, University of California in San Diego Health System, San Diego, CA, USA
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De Lisa M, Ballatore Z, Marcantognini G, Pierantoni C, Antognoli S, Pistelli M, Pagliacci A, Berardi R. Irinotecan-Induced Transient Dysarthria: Case Series and Updated Literature Review. Oncol Ther 2020; 8:147-160. [PMID: 32700070 PMCID: PMC7359989 DOI: 10.1007/s40487-019-00106-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Indexed: 12/27/2022] Open
Abstract
Irinotecan-based regimens are used worldwide for the treatment of several recurrent or advanced gastrointestinal malignancies. In this paper we describe the cases of four patients treated in our institution who developed acute dysarthria while receiving intravenous infusion of irinotecan. In all our cases, dysarthria occurred during the infusion of the first course of irinotecan, and then resolved rapidly without any sequelae. Imaging of the brain was performed, but failed to show any evidence of an acute neurological event. We also reviewed the literature on this very uncommon adverse event. The pathogenesis of irinotecan-induced dysarthria is still unknown and is not completely elucidated by the current pharmacodynamic or kinetic explanations; therefore, we could only hypothesize some assumptions.
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Affiliation(s)
- Mariagrazia De Lisa
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Zelmira Ballatore
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Giulia Marcantognini
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Chiara Pierantoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Stefania Antognoli
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Mirco Pistelli
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandra Pagliacci
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Rossana Berardi
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy.
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Acute Peripheral Motor Neuropathy Induced by Oxaliplatin-Correlated Hypokalaemia. Oncol Ther 2020; 8:161-169. [PMID: 32700068 PMCID: PMC7360012 DOI: 10.1007/s40487-019-00102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Indexed: 11/05/2022] Open
Abstract
Neurotoxicity is one of the most common side effects of oxaliplatin-based therapy. Most patients who receive at least 3–4 months of treatment suffer from peripheral sensory neurotoxicity (PSN), characterised by the loss or impairment of tactile and proprioceptive sensory function. Motor impairment, such as muscle weakness or palsy, has been rarely described, and the physiopathology of PSN, as well as the motor symptoms due to oxaliplatin-based treatment, are not adequately understood. Here we report the case of a patient who experienced severe acute peripheral motor neuropathy as a side effect of oxaliplatin-based treatment. We also review other cases of PSN published in the literature and suggest a novel hypothesis on the physiopathology of this particular event. Take-away lessons: Not all of the neurological symptoms observed during oxaliplatin-based treatment can be traced back directly to the oxaliplatin itself, and other factors, such as electrolyte imbalances, may contribute to the symptoms. Patients with gastro-intestinal malignancies are the patients most affected by neurotoxicity due to the side effects of chemotherapy and the disease itself.
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Kopjar N, Fuchs N, Brčić Karačonji I, Žunec S, Katić A, Kozina G, Lucić Vrdoljak A. High Doses of Δ 9-Tetrahydrocannabinol Might Impair Irinotecan Chemotherapy: A Review of Potentially Harmful Interactions. Clin Drug Investig 2020; 40:775-787. [PMID: 32696321 DOI: 10.1007/s40261-020-00954-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This review proposes the hypothesis that the effectiveness of irinotecan chemotherapy might be impaired by high doses of concomitantly administered Δ9-tetrahydrocannabinol (THC). The most important features shared by irinotecan and THC, which might represent sources of potentially harmful interactions are: first-pass hepatic metabolism mediated by cytochrome P450 (CYP) enzyme CYP3A4; glucuronidation mediated by uridine diphosphate glycosyltransferase (UGT) enzymes, isoforms 1A1 and 1A9; transport of parent compounds and their metabolites via canalicular ATP-binding cassette (ABC) transporters ABCB1 and ABCG2; enterohepatic recirculation of both parent compounds, which leads to an extended duration of their pharmacological effects; possible competition for binding to albumin; butyrylcholinesterase (BChE) inhibition by THC, which might impair the conversion of parent irinotecan into the SN-38 metabolite; mutual effects on mitochondrial dysfunction and induction of oxidative stress; potentiation of hepatotoxicity; potentiation of genotoxicity and cytogenetic effects leading to genome instability; possible neurotoxicity; and effects on bilirubin. The controversies associated with the use of highly concentrated THC preparations with irinotecan chemotherapy are also discussed. Despite all of the limitations, the body of evidence provided here could be considered relevant for human-risk assessments and calls for concern in cases when irinotecan chemotherapy is accompanied by preparations rich in THC.
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Affiliation(s)
- Nevenka Kopjar
- Mutagenesis Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Nino Fuchs
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Irena Brčić Karačonji
- Analytical Toxicology and Mineral Metabolism Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia.
| | - Suzana Žunec
- Toxicology Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Anja Katić
- Analytical Toxicology and Mineral Metabolism Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Goran Kozina
- University Centre Varaždin, University North, Varaždin, Croatia
| | - Ana Lucić Vrdoljak
- Toxicology Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia
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Zhen DB, McDevitt RL, Zalupski MM, Sahai V. Irinotecan-associated dysarthria: A single institution case series with management implications in patients with gastrointestinal malignancies. J Oncol Pharm Pract 2018; 25:980-986. [PMID: 29562843 DOI: 10.1177/1078155218763044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Irinotecan (Camptosar©, CPT-11), a topoisomerase I inhibitor, is a commonly used cytotoxic chemotherapeutic in the treatment of multiple malignancies, particularly of gastrointestinal origin. Dysarthria secondary to irinotecan has been described as a rare side effect in a few case reports with limited data to recommend appropriate management. We describe herein a large single institution experience of patients with gastrointestinal malignancies who experienced dysarthria while being treated with irinotecan-based chemotherapy regimens (FOLFIRINOX or FOLFIRI+/-bevacizumab). Eighteen patients developed neurological manifestations during irinotecan infusion with the majority ( n = 17) developing dysarthria. Patients also experienced other known side effects including cholinergic effects (abdominal bloating, diarrhea, facial flushing, diaphoresis, and rhinorrhea), nausea, fatigue, perioral paresthesia and musculoskeletal discomfort. The dysarthria occurred as early as with the first infusion of irinotecan ( n = 9), but several patients did not develop symptoms until subsequent infusions (range, 1-6). Dose alterations of irinotecan did not obviously impact the reccurrence or severity of dysarthria. Management strategies included close observation, atropine, slower irinotecan infusion rate, and reassurance. Dysarthria resolved without consequence in all patients within hours of completion of the infusion. Oncologists and pharmacists should be aware of irinotecan-associated dysarthria as a rare, self-limited phenomenon with no long-term sequelae, and appropriately counsel patients and infusion nurses to avoid inadvertently withholding potentially beneficial therapy for patients with gastrointestinal malignancies.
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Affiliation(s)
- David B Zhen
- 1 Division of Oncology, University of Washington, Seattle, WA, USA
| | - Rachel L McDevitt
- 2 Department of Pharmacy, Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Mark M Zalupski
- 3 Division of Hematology/Oncology, Department of Internal Medicine, Comprehensive Cancer Center, University of Michigan Ann Arbor, MI, USA
| | - Vaibhav Sahai
- 3 Division of Hematology/Oncology, Department of Internal Medicine, Comprehensive Cancer Center, University of Michigan Ann Arbor, MI, USA
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Chemotherapy induced stroke mimic: 5-Fluorouracil encephalopathy fulfilling criteria for tissue plasminogen activator therapy. Am J Emerg Med 2017; 35:1389-1390. [DOI: 10.1016/j.ajem.2017.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/06/2017] [Indexed: 11/21/2022] Open
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Peters SS, Bettinger J, Philip J, Karhan B, Wrzesinski SH. Irinotecan-induced muscle twitching from a possible drug interaction: A case report. J Oncol Pharm Pract 2017; 24:555-560. [PMID: 28747102 DOI: 10.1177/1078155217723696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the case of a 50-year-old human immunodeficiency virus-positive patient with stage IV KRAS-mutated colorectal cancer who experienced visible muscle twitching in the right lateral triceps brachii from irinotecan administration for which typical supportive care measures were unsuccessful, including the administration of atropine and slowing down the infusion rate. The patient was able to tolerate this reaction and received 20 cycles of irinotecan-based chemotherapy despite experiencing the muscle twitching with every cycle at the same onset, duration, and severity. It is possible that competitive metabolism by concomitant medications metabolized by CYP3A4 or UGT1A1 was responsible for this event. Due to ethical concerns, we were unable to formally assess the drug interaction by discontinuing the suspected interacting medications and re-initiating them to evaluate the effects. A formal pharmacokinetic study may be warranted to better elucidate these potential drug interactions.
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Affiliation(s)
- S S Peters
- 1 Albany College of Pharmacy and Health Sciences, Albany, NY, USA.,2 St. Peter's Health Partners Cancer Care Center, Albany, NY, USA
| | - J Bettinger
- 1 Albany College of Pharmacy and Health Sciences, Albany, NY, USA
| | - J Philip
- 1 Albany College of Pharmacy and Health Sciences, Albany, NY, USA
| | - B Karhan
- 2 St. Peter's Health Partners Cancer Care Center, Albany, NY, USA
| | - S H Wrzesinski
- 2 St. Peter's Health Partners Cancer Care Center, Albany, NY, USA
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Jamal S, Goyal S, Shanker A, Grover A. Predicting neurological Adverse Drug Reactions based on biological, chemical and phenotypic properties of drugs using machine learning models. Sci Rep 2017; 7:872. [PMID: 28408735 PMCID: PMC5429831 DOI: 10.1038/s41598-017-00908-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/16/2017] [Indexed: 02/07/2023] Open
Abstract
Adverse drug reactions (ADRs) have become one of the primary reasons for the failure of drugs and a leading cause of deaths. Owing to the severe effects of ADRs, there is an urgent need for the generation of effective models which can accurately predict ADRs during early stages of drug development based on integration of various features of drugs. In the current study, we have focused on neurological ADRs and have used various properties of drugs that include biological properties (targets, transporters and enzymes), chemical properties (substructure fingerprints), phenotypic properties (side effects (SE) and therapeutic indications) and a combinations of the two and three levels of features. We employed relief-based feature selection technique to identify relevant properties and used machine learning approach to generated learned model systems which would predict neurological ADRs prior to preclinical testing. Additionally, in order to explain the efficiency and applicability of the models, we tested them to predict the ADRs for already existing anti-Alzheimer drugs and uncharacterized drugs, respectively in side effect resource (SIDER) database. The generated models were highly accurate and our results showed that the models based on chemical (accuracy 93.20%), phenotypic (accuracy 92.41%) and combination of three properties (accuracy 94.18%) were highly accurate while the models based on biological properties (accuracy 82.11%) were highly informative.
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Affiliation(s)
- Salma Jamal
- Department of Bioscience and Biotechnology, Banasthali University, Tonk, Rajasthan, India
| | - Sukriti Goyal
- Department of Bioscience and Biotechnology, Banasthali University, Tonk, Rajasthan, India
| | - Asheesh Shanker
- Department of Bioscience and Biotechnology, Banasthali University, Tonk, Rajasthan, India.,Bioinformatics Programme, Centre for Biological Sciences, Central University of South Bihar, BIT Campus, Patna, Bihar, India
| | - Abhinav Grover
- School of Biotechnology, Jawaharlal Nehru University, New Delhi, India.
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Le N, Sund M, Vinci A. Prognostic and predictive markers in pancreatic adenocarcinoma. Dig Liver Dis 2016; 48:223-30. [PMID: 26769569 DOI: 10.1016/j.dld.2015.11.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/27/2015] [Accepted: 11/01/2015] [Indexed: 12/11/2022]
Abstract
Pancreatic ductal adenocarcinoma is characterized by a poor prognosis and a low median survival, despite improvements observed for many other solid tumours. Intensive research efforts have been undertaken during the last decades to discover new prognostic and treatment predictive biomarkers for pancreatic ductal adenocarcinoma. The mainstay of medical treatment for the disease has been the well-tolerated nucleoside analogue, gemcitabine. The only targeted agent currently used in pancreatic ductal adenocarcinoma patients is the epithelial growth factor receptor inhibitor erlotinib in combination with gemcitabine. Recently, treatment regimens such as a combination of fluorouracil-leucovorin-irinotecan-oxaliplatin (FOLFIRINOX) and the combination of nab-paclitaxel with gemcitabine have been introduced for metastatic pancreatic ductal adenocarcinoma. Although these treatment regimens significantly improve survival of patients, there are no good predictive biomarkers available that can be used to identify who would benefit most from them. Therefore, the search for predictive biomarkers that would facilitate personalization of chemotherapy is highly relevant.
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Affiliation(s)
- Nha Le
- Semmelweis University, Second Internal Medicine Department, Gastroenterology Division, Budapest, Hungary
| | - Malin Sund
- University of Umeå, Department of Surgical and Perioperative Sciences, Umeå, Sweden.
| | - Alessio Vinci
- University of Pavia, Department of Surgery, IRCCS S. Matteo University Hospital Foundation, Pavia, Italy
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