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Resident Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara, Turkey
Resident Department of Internal Medicine Hacettepe University Faculty of Medicine
Specialist of Internal Medicine and Medical Oncology Department of
Medical Oncology Hacettepe University Oncology Institute 06100-S
hhiye
Ankara, Turkey fax 90-312-3242009
bulengin{at}yahoo.com
Professor of Internal Medicine and Medical Oncology Department of Medical Oncology Hacettepe University Oncology Institute
Published Online, March 23, 2004. www.theannals.com, DOI 10.1345/aph.1D164
Case Report. A 42-year-old woman with the diagnosis of stage IIIB, invasive ductal-type carcinoma of the breast had been given 4 cycles of an anthracyline-containing neoadjuvant chemotherapy regimen, which yielded partial response. Left modified radical mastectomy was performed in July 2001. She was further treated with radiation therapy and 3 more cycles of the same neoadjuvant chemotherapy regimen.
While she was in complete remission, multiple metastatic lesions were detected in the liver by abdominal ultrasonography in March 2002. Thereafter, docetaxel 60 mg/wk was prescribed. Partial response was obtained after 7 weeks (total dose 420 mg). The docetaxel dosage was adjusted to 170 mg every 3 weeks in May 2002. She was given 5 cycles of that regimen until July 2002. The total dose of docetaxel the woman received was 1270 mg.
Progression in the liver lesions was noted on August 24, 2002. Therefore, capecitabine was initiated at the dosage of 1250 mg/m2 twice daily. On August 25, only 11 hours after the first oral dose of capecitabine 2250 mg, she presented with complaints of excessive nausea, vomiting, lumbar pain, difficulty walking, dysarthria, and confusion. The patient became comatose a few hours after the development of symptoms, and the calculated Glasgow coma scale was 11. She also had severe hypotension and metabolic acidosis. A cranial computed tomography scan was completely normal. She was diagnosed with tumor lysis syndrome on the basis of laboratory values (Table 1) due to capecitabine treatment. Two days later, the patient became hypothermic (33 °C). Bradycardia and then asystole developed. There was no response to resuscitation. The patient died of multiorgan failure due to tumor lysis syndrome associated with capecitabine.
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Discussion. As of March 1, 2004, to our knowledge, tumor lysis syndrome has never been reported with the use of capecitabine. Use of the Naranjo probability scale indicated a probable relationship between capecitabine and tumor lysis syndrome.4
References
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