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Imamaki H, Oura M, Oguro F, Nishikawa Y, Nakagawa S, Funakoshi T, Kataoka S, Horimatsu T, Yonezawa A, Matsubara T, Watanabe N, Muto M, Yanagita M, Ozaki Y. Removal rate of 5-fluorouracil and its metabolites in patients on hemodialysis: a report of two cases of colorectal cancer patients with end-stage renal failure. Cancer Chemother Pharmacol 2024; 93:161-167. [PMID: 37608127 PMCID: PMC10853355 DOI: 10.1007/s00280-023-04577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/06/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE Hyperammonemia is a serious adverse effect of 5-fluorouracil (5FU) administration. Hemodialysis can be used for its management, but detailed data on the concentrations and removal rate of 5FU and its metabolites during hemodialysis remain unclear. Here, we present two cases of hemodialysis patients with end-stage renal disease who received concurrent 5FU infusion. METHODS Blood samples were collected from the hemodialysis circuit before and after the dialyzer during day 2 hemodialysis sessions, and from the internal shunt just before and after day 4 hemodialysis sessions. The serum levels of 5FU and its metabolites-α-fluoro-β-alanine (FBAL) and monofluoroacetate (FA)-were measured using liquid chromatography-tandem mass spectrometry. RESULTS Seven sets of blood samples were collected for case 1; the removal rates (mean ± standard deviation) of 5FU and FBAL by the dialyzer were 81.2 ± 23.2% and 96.1 ± 8.6%, respectively (p < 0.001). Three sets of blood samples were collected for case 2; the removal rates of 5FU and FBAL were 81.7 ± 3.9% and 94.8 ± 2.7%, respectively (p = 0.03). Twenty-seven sets of blood samples were collected for case 1; reductions in blood FBAL and FA levels were 49.3 ± 8.8% (p < 0.001) and 64.2 ± 30.3% (p = 0.04), respectively. Bayesian estimation yielded similar results. Three sets of blood samples were collected for case 2; reductions in the blood FBAL and FA levels were 49.9 ± 6.9% and 50.6 ± 33.0%, respectively. CONCLUSION In this study, 5FU and its metabolite FBAL were directly removed from the blood by approximately 90% during hemodialysis, and the blood levels of FBAL and FA were reduced by approximately 50% with a single hemodialysis session.
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Affiliation(s)
- Hirotaka Imamaki
- Department of Nephrology, Hirakata Kohsai Hospital, Osaka, Japan.
| | - Mitsuaki Oura
- Division of Hematology/Oncology, Kameda Medical Center, Chiba, Japan
| | - Fumiya Oguro
- Department of Internal Medicine, Hirata Central Hospital, Fukushima, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shunsaku Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Taro Funakoshi
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeki Kataoka
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahiro Horimatsu
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Yonezawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Takeshi Matsubara
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Norihiko Watanabe
- Department of Gastroenterology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motoko Yanagita
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshinao Ozaki
- Department of Gastroenterology, Hirakata Kohsai Hospital, Osaka, Japan
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2
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Ozaki Y, Imamaki H, Ikeda A, Oura M, Nakagawa S, Funakoshi T, Kataoka S, Nishikawa Y, Horimatsu T, Yonezawa A, Matsubara T, Yanagita M, Muto M, Watanabe N. Successful management of hyperammonemia with hemodialysis on day 2 during 5-fluorouracil treatment in a patient with gastric cancer: a case report with 5-fluorouracil metabolite analyses. Cancer Chemother Pharmacol 2020; 86:693-699. [PMID: 33011861 PMCID: PMC7595983 DOI: 10.1007/s00280-020-04158-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/24/2020] [Indexed: 12/01/2022]
Abstract
Purpose Hyperammonemia is an important adverse event associated with
5-fluorouracil (5FU) from 5FU metabolite accumulation. We present a case of an
advanced gastric cancer patient with chronic renal failure, who was treated with
5FU/leucovorin (LV) infusion chemotherapy (2-h infusion of LV and 5FU bolus followed
by 46-h 5FU continuous infusion on day 1; repeated every 2 weeks) and developed
hyperammonemia, with the aim of exploring an appropriate hemodialysis (HD) schedule
to resolve its symptoms. Methods The blood concentrations of 5FU and its metabolites, α-fluoro-β-alanine
(FBAL), and monofluoroacetate (FA) of a patient who had hyperammonemia from seven
courses of palliative 5FU/LV therapy for gastric cancer were measured by liquid
chromatography–mass spectrometry. Results On the third day of the first cycle, the patient presented with
symptomatic hyperammonemia relieved by emergency HD. Thereafter, the 5FU dose was
reduced; however, in cycles 2–4, the patient developed symptomatic hyperammonemia and
underwent HD on day 3 for hyperammonemia management. In cycles 5–7, the timing of
scheduled HD administration was changed from day 3 to day 2, preventing symptomatic
hyperammonemia. The maximum ammonia and 5FU metabolite levels were significantly
lower in cycles 5–7 than in cycles 2–4 (NH3 75 ± 38 vs 303 ± 119 μg/dL, FBAL
13.7 ± 2.5 vs 19.7 ± 2.0 μg/mL, FA 204.0 ± 91.6 vs 395.9 ± 12.6 ng/mL,
mean ± standard deviation, all p < 0.05). After
seven cycles, partial response was confirmed. Conclusion HD on day 2 instead of 3 may prevent hyperammonemia in 5FU/LV
therapy. Electronic supplementary material The online version of this article (10.1007/s00280-020-04158-1) contains supplementary material, which is available to authorized
users.
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Affiliation(s)
- Yoshinao Ozaki
- Department of Gastroenterology, Hirakata Kohsai Hospital, Osaka, Japan.
| | - Hirotaka Imamaki
- Department of Nephrology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Aki Ikeda
- Department of Gastroenterology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Mitsuaki Oura
- Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shunsaku Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Taro Funakoshi
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeki Kataoka
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshitaka Nishikawa
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takahiro Horimatsu
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Yonezawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Takeshi Matsubara
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Motoko Yanagita
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Norihiko Watanabe
- Department of Gastroenterology, Hirakata Kohsai Hospital, Osaka, Japan
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3
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Fukuda M, Nabeta M, Muta T, Cho T, Shimamatsu Y, Shimotsuura Y, Fukami K, Takasu O. Disturbance of consciousness due to hyperammonemia and lactic acidosis during mFOLFOX6 regimen: Case report. Medicine (Baltimore) 2020; 99:e21743. [PMID: 32872062 PMCID: PMC7437776 DOI: 10.1097/md.0000000000021743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION FOLFOX therapy is the main chemotherapy regimen for colorectal cancer. Peripheral neuropathy, hematotoxicity, and digestive symptoms are known to be the most frequent adverse events. Hyperammonemia and lactic acidosis rarely occur simultaneously during treatment with FOLFOX therapy; the number of case reports is limited worldwide. We report a case of disturbance of consciousness, considered to be caused by hyperammonemia and lactic acidosis that occurred during treatment with mFOLFOX6 therapy that was administered as postoperative adjuvant treatment for rectal cancer. PATIENT CONCERNS This case was of a 71-year-old man who had been receiving oral treatment for chronic kidney disease and diabetes mellitus. Laparoscopic low anterior resection and artificial anal construction surgery were performed for stage III rectal cancer. As adjuvant postoperative therapy, mFOLFOX6 therapy was started but was followed by a disturbance of consciousness. DIAGNOSES Results of the blood tests revealed notable hyperammonemia (ammonia level, 1,163 μg/dl) and lactic acidosis (pH 7.207; lactate, 17.56 mmol/L); however, imaging diagnosis did not reveal intracranial lesions that could cause disturbance of consciousness. INTERVENTIONS For hyperammonemia, branched-chain amino acid agents and Ringers solution supplementation were administered. For acidosis, 7% sodium hydrogen carbonate was administered as treatment. OUTCOMES The disturbance of consciousness improved within 12 hours of initiating the treatment, and the patient was discharged with no sequelae on 7th day after hospitalization. CONCLUSION In patients with chronic kidney disease, FOLFOX regimen may confer risks of hyperammonemia and lactic acidosis.
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Affiliation(s)
- Masafumi Fukuda
- Advanced Emergency and Critical Care Center, Kurume University Hospital
| | | | - Takanori Muta
- Department of Emergency and Acute Intensive Care Medicine
| | | | | | | | - Kei Fukami
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Osamu Takasu
- Department of Emergency and Acute Intensive Care Medicine
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Marella HK, Peravali R, Jain AL, Nair S, Maliakkal B, Agbim U, Verma R. Hyperammonemic encephalopathy associated with 5-fluorouracil in a patient with previous orthotopic liver transplantation. Proc (Bayl Univ Med Cent) 2020; 33:256-257. [DOI: 10.1080/08998280.2019.1708689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Hemnishil K. Marella
- Department of Gastroenterology and Hepatology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Rahul Peravali
- Department of Gastroenterology and Hepatology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Amit L. Jain
- Department of Gastroenterology and Hepatology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Satheesh Nair
- Department of Gastroenterology and Hepatology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Benedict Maliakkal
- Department of Gastroenterology and Hepatology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Uchenna Agbim
- Department of Gastroenterology and Hepatology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Rajanshu Verma
- Department of Gastroenterology and Hepatology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
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Mitani S, Kadowaki S, Komori A, Sugiyama K, Narita Y, Taniguchi H, Ura T, Ando M, Sato Y, Yamaura H, Inaba Y, Ishihara M, Tanaka T, Tajika M, Muro K. Acute hyperammonemic encephalopathy after fluoropyrimidine-based chemotherapy: A case series and review of the literature. Medicine (Baltimore) 2017; 96:e6874. [PMID: 28562536 PMCID: PMC5459701 DOI: 10.1097/md.0000000000006874] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Acute hyperammonemic encephalopathy induced by fluoropyrimidines (FPs) is a rare complication. Its pathophysiology remains unclear, especially given the currently used regimens, including intermediate-doses of 5-fluorouracil (5-FU) or oral FP agents. We aimed to characterize the clinical manifestations in cancer patients who developed hyperammonemic encephalopathy after receiving FP-based chemotherapy.We retrospectively reviewed 1786 patients with gastrointestinal or primary-unknown cancer who received FP-based regimens between 2007 and 2012. Eleven patients (0.6%) developed acute hyperammonemic encephalopathy. The incidence according to the administered anticancer drugs were as follows: 5-FU (8 of 1176, 0.7%), S-1 (1 of 679, 0.1%), capecitabine (2 of 225, 0.9%), and tegafur-uracil (UFT) (0 of 39, 0%). Ten patients (90.9%) had at least 1 aggravating factor, including infection, dehydration, constipation, renal dysfunction, and muscle loss. All the 10 patients met the definition of sarcopenia. Median time to the onset of hyperammonemic encephalopathy in the cycle was 3 days (range: 2-21). Three patients (27.3%) developed encephalopathy during the first cycle of the regimen and the remaining 8 patients during the second or more cycles. Seven patients (63.6%) had received at least 1 other FP-containing regimen before without episodes of encephalopathy.All patients recovered soon after immediate discontinuation of chemotherapy and supportive therapies, such as hydration, infusion of branched-chain amino acids, and oral lactulose intake, with a median time to recovery of 2 days (range: <1-7). Four patients (36.4%) received FP-based regimens after improvement of symptoms; 3 patients were successfully managed with dose reduction, and 1 patient, who had developed encephalopathy due to S-1 monotherapy, received modified FOLFOX-6 therapy without encephalopathy later.FP-associated acute hyperammonemic encephalopathy is extremely rare, but a possible event at any time and even during the administration of oral FP agents. Particular attention is warranted when giving FP-based therapy for patients with aggravating factors, such as sarcopenia. This complication can be properly managed with early detection.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yozo Sato
- Department of Diagnostic and Interventional Radiology
| | | | | | - Makoto Ishihara
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tsutomu Tanaka
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masahiro Tajika
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
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Liu B, Yu M, Song YX, Gao P, Xu HM, Wang ZN. Surgery for gastric cancer in a patient with non-cirrhotic hyperammonemia: a case report. World J Surg Oncol 2015; 13:76. [PMID: 25890120 PMCID: PMC4342035 DOI: 10.1186/s12957-015-0500-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/01/2015] [Indexed: 02/06/2023] Open
Abstract
We report a case of gastric cancer in a patient with non-cirrhotic hyperammonemia secondary to a spontaneous portacaval shunt. The patient, a 69-year-old male, had more than 40 years of abdominal discomfort. On gastroscopy, 2.0 × 1.5-cm irregular uplift ulcers were seen on the lesser curvature of the stomach, and tissue biopsy revealed poorly differentiated adenocarcinoma. His hyperammonemia was found on celiac angiography to be due to the formation of a spontaneous portacaval shunt. Imaging revealed no evidence of cirrhosis or portal hypertension. The patient ultimately underwent a distal gastrectomy and gastroduodenal anastomosis; the spontaneous portacaval shunt was left untreated. Postoperatively, there were no short-term complications such as anastomotic leakage, stricture, or bleeding, and the patient’s blood ammonia level decreased to within the normal range. Radical gastrectomy without splenectomy or closure of the abnormal shunt was feasible for the treatment of gastric cancer in a patient with non-cirrhotic hyperammonemia.
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Affiliation(s)
- Bo Liu
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City, 110001, China.
| | - Miao Yu
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City, 110001, China.
| | - Yong-xi Song
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City, 110001, China.
| | - Peng Gao
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City, 110001, China.
| | - Hui-mian Xu
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City, 110001, China.
| | - Zhen-ning Wang
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City, 110001, China.
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A multicenter phase II study of biweekly capecitabine in combination with oxaliplatin as first-line chemotherapy in patients with locally advanced or metastatic gastric cancer. Cancer Chemother Pharmacol 2014; 73:799-806. [PMID: 24531611 PMCID: PMC3965832 DOI: 10.1007/s00280-014-2407-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/29/2014] [Indexed: 11/08/2022]
Abstract
Purpose
We evaluated the safety and efficacy of biweekly capecitabine in combination with oxaliplatin in previously untreated patients with locally advanced or metastatic gastric cancer. Methods Patients received oral capecitabine 1,000 mg/m2 twice daily on days 1–10 plus oxaliplatin 85 mg/m2 as a 2-h intravenous infusion on day 1, every 2 weeks (XELOX). The primary endpoint was overall response rate. Secondary endpoints included progression-free survival, overall survival, and toxicity. Results From March 2007 to October 2010, 46 patients were enrolled in this phase II study. The median age was 64 years (range 32–85). A total of 391 (median 7.5, range 1–29) cycles were delivered. Among the 41 patients evaluable for tumor response, 9 showed partial response and 25 had stable disease. The overall response rates of the evaluable and intent-to-treat (ITT) populations were 22 % (95 % CI 10–42 %) and 20 % (95 % CI 9–34 %), respectively. In the ITT analysis, the progression-free survival and overall survival were 5.6 months (95 % CI 4.1–6.3 months) and 8.0 months (95 % CI 6.3–10.1 months), respectively. The most common hematological toxicities were thrombocytopenia (35 %) and leucopenia (34 %), whereas the most common non-hematological toxicities were neuropathy (35 %), fatigue (33 %), diarrhea (27 %), vomiting (26 %), and hand-foot syndrome (25 %). Major grade 3–4 toxicities were anemia (11 %), diarrhea (9 %), and hand-foot syndrome (7 %). No patient died of treatment-related toxicities. Conclusions Although the biweekly XELOX regimen failed its primary response rate endpoint, it showed modest efficacy and an acceptable safety profile in the treatment of advanced gastric cancer.
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Turken O, Basekim C, Haholu A, Karagoz B, Bilgi O, Ozgun A, Kucukardali Y, Narin Y, Yazgan Y, Kandemir EG. Hyperammonemic encephalopathy in a patient with primary hepatic neuroendocrine carcinoma. Med Oncol 2008; 26:309-13. [PMID: 19031017 DOI: 10.1007/s12032-008-9121-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Accepted: 10/21/2008] [Indexed: 01/09/2023]
Abstract
A 53-year-old male patient was admitted to our hospital with abdominal pain in the right upper quadrant. There was no change in laboratory investigations other than a slight increase in serum levels of alkaline phosphatase (ALP), alanine aminotransferase (ALT), and gamma glutamyl transferase (GGT). Computed tomography (CT) of the abdomen showed multiple hepatic nodular lesions in the liver. Tru-cut biopsy of the lesions was reported as well-differentiated neuroendocrine carcinoma. The patient received sandostatin treatment. After a few days, the patient was hospitalized in the intensive care unit with disturbance of consciousness and clinical features suggestive of encephalopathy. Serum ammonia level was found highly elevated. After the treatment with L-ornithine-L-aspartate, a remarkable improvement in the level of patient's sensorium occurred as well as a reduction in serum ammonia level within a few days. Transarterial chemoembolization (TACE) was performed one week later. The patient's condition began to worsen along with increase in serum ammonia level and he died because of hyperammonemic encephalopathy. There are case reports of hyperammonemia with some malignancies such as multiple myeloma, plasma cell leukemia, and leiomyosarcoma, or in some patients who have received chemotherapy. This case may suggest an association between hyperammonemia and neuroendocrine tumors.
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Affiliation(s)
- Orhan Turken
- Medical Oncology Department, GATA Haydarpasa Training Hospital, Haydarpasa, Uskudar, Istanbul, Turkey.
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9
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Kikuta S, Asakage T, Nakao K, Sugasawa M, Kubota A. The aggravating factors of hyperammonemia related to 5-fluorouracil infusion—A report of two cases. Auris Nasus Larynx 2008; 35:295-9. [PMID: 17826933 DOI: 10.1016/j.anl.2007.04.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 03/09/2007] [Accepted: 04/22/2007] [Indexed: 11/23/2022]
Abstract
Hyperammonemia or hyperammonemic leukoencephalopathy sometimes occurs as an adverse event after 5-fluorouracil (5-FU) chemotherapy. The actual mechanism responsible for hyperammonemia by 5-FU administration is not known. Patient 1, a 48-year-old woman with cervical esophageal squamous cell carcinoma (SCC) presented with transient hyperammonemic leukoencephalopathy after undergoing combined chemotherapy (750mg/body/day of 5-FU for 5 days+100mg/body/day of cisplatin). Patient 2, a 58-year-old man with oropharyngeal and lower esophageal SCCs presented with hyperammonemia without leukoencephalopathy while undergoing combined chemotherapy (1200mg/body/day of 5-FU for 5 days+120mg/body/day of cisplatin). The neural symptoms of both patients improved after the termination of 5-FU administration and the early administration of fluid replacement. Ammonia can accumulate in the body when catabolism is insufficient because of an impairment in the urea cycle. The excess production of ammonium from 5-FU catabolites in addition to aggravating factors, e.g., renal dysfunction, constipation and body weight loss, may explain the transient hyperammonemia seen in the present two cases. The incidence of hyperammonemia by 5-FU administration will be one of the adverse events to need care in future and may be decreased by being aware of the presence of renal dysfunction, taking measures to prevent constipation, and nutritional management.
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Affiliation(s)
- Shu Kikuta
- Department of Otolaryngology, Faculty of Medicine, University of Tokyo,7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Chao Y, Li CP, Chao TY, Su WC, Hsieh RK, Wu MF, Yeh KH, Kao WY, Chen LT, Cheng AL. An open, multi-centre, phase II clinical trial to evaluate the efficacy and safety of paclitaxel, UFT, and leucovorin in patients with advanced gastric cancer. Br J Cancer 2006; 95:159-63. [PMID: 16804524 PMCID: PMC2360611 DOI: 10.1038/sj.bjc.6603225] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The aim of the study was to evaluate the response rate and safety of weekly paclitaxel (Taxol((R))) combination chemotherapy with UFT (tegafur, an oral 5-fluorouracil prodrug, and uracil at a 1 : 4 molar ratio) and leucovorin (LV) in patients with advanced gastric cancer. Patients with histologically confirmed, locally advanced or recurrent/metastatic gastric cancer were studied. Paclitaxel 1-h infusion at a dose of 100 mg m(-2) on days 1 and 8 and oral UFT 300 mg m(-2) day(-1) plus LV 90 mg day(-1) were given starting from day 1 for 14 days, followed by a 7-day period without treatment. Treatment was repeated every 21 days. From February 2003 to October 2004, 55 patients were enrolled. The median age was 62 years (range: 32-82). Among the 48 patients evaluated for tumour response, two achieved a complete response and 22 a partial response, with an overall response rate of 50% (95% confidence interval: 35-65%). All 55 patients were evaluated for survival and toxicities. Median time to progression and overall survival were 4.4 and 9.8 months, respectively. Major grade 3-4 toxicities were neutropenia in 25 patients (45%) and diarrhoea in eight patients (15%). Although treatment was discontinued owing to treatment-related toxicities in nine patients (16%), there was no treatment-related mortality. Weekly paclitaxel plus oral UFT/LV is effective, convenient, and well tolerated in treating patients with advanced gastric cancer.
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Affiliation(s)
- Y Chao
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Central Clinic Hospital, Taipei, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - C P Li
- National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - T Y Chao
- Division of Hematology and Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - W C Su
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - R K Hsieh
- Division of Hematology and Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - M F Wu
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - K H Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Oncology and Hematology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - W Y Kao
- Division of Hematology and Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - L T Chen
- Institute of Cancer Research, National Health Research Institutes, Taipei, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Institute of Cancer Research, National Health Research Institutes, Taipei Veterans General Hospital, Ward 191, No. 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan. E-mail:
| | - A L Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine and Department of Oncology, National Taiwan University Hospital, No. 2, Chung-Shan S Rd, Taipei 100, Taiwan. E-mail:
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Chan CH, Liu TW, Chen LT, Chang JY, Whang-Peng J. Long-term complete remission of metastatic gastric cancer after weekly docetaxel, 24 h infusion of high-dose 5-FU/leucovorin and cisplatin. J Gastroenterol Hepatol 2005; 20:1470-1. [PMID: 16105146 DOI: 10.1111/j.1440-1746.2005.03912.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Lee WS, Lee GW, Kim HW, Lee OJ, Lee YJ, Ko GH, Lee JS, Jang JS, Ha WS. A phase II trial of haptaplatin/5-FU and leucovorin for advanced stomach cancer. Cancer Res Treat 2005; 37:208-11. [PMID: 19956515 DOI: 10.4143/crt.2005.37.4.208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2005] [Accepted: 07/02/2005] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Heptaplatin (SKI-2053 R) is a new platinum analogue, with a better toxicity profile than cisplatin, and has antitumor activity even in cisplatin resistant cell lines. 5-fluoruracil (5-FU) has shown synergy with platinum compounds. This phase II trial was designed to determine the efficacy and toxicities of heptaplatin/ 5-FU (5-fluorouracil) for treating stomach cancer. MATERIALS AND METHODS Thirty-two patients with advanced, measurable gastric adenocarcinomas were enrolled in this trial. The treatment consisted of heptaplatin, 400 mg/m(2)/day (1 hour IV infusion), on day 1 and 5-FU, 800 mg/m(2)/day (12 hours IV infusion), on days 1 to 5. The cycles were repeated every 3 weeks. RESULTS Of the 26 evaluable patients, 9 had partial responses and 1a complete response (overall response rate, 38%; 95% confidence interval, 19 approximately 57%). The median response duration was 23 weeks (range: 4 approximately 60 weeks). The median time to progression was 26 weeks (range: 3 approximately 68 weeks). The grades III-IV toxicities were mostly hematological toxicities: leucopenia was observed in 11 patients (35%) and thrombocytopenia 4 (13%). No definite neuropathy was observed. Grade I-II nephropathy was also noted: grade I high BUN/creatinine levels occurred in 5 patients (16%), grade II proteinuria 2 (6%), grade I proteinuria 5 (16%). Neutropenic fever developed in 5 patients (16%) and 1 died of pneumonia in a neutropenic state. CONCLUSION This study suggests that the regimen of Heptaplatin/5-FU should be effective and have a favorable toxicity profile for the patients suffering with advanced stomach cancer.
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Affiliation(s)
- Won Sup Lee
- Department of Internal Medicine, College of Medicine, Gyeong-Sang National University, Jinju, Korea.
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