levoleucovorin and Respiratory-Insufficiency

Oxaliplatin-based chemotherapy regimens are currently a standard of care for the treatment of colorectal cancer in both the adjuvant and metastatic disease settings. Significant improvements in survival have resulted from the use of oxaliplatin-based combinations. This article describes the use of oxaliplatin-based chemotherapy in a patient with stage III colon cancer who developed fatal diffuse alveolar damage during his adjuvant therapy. Other cases of pulmonary toxicity associated with oxaliplatin use are presented and the proposed pathophysiology of this rare occurrence is discussed.

Topics: Acute Lung Injury; Aged; Antineoplastic Combined Chemotherapy Protocols; Colonic Neoplasms; Fatal Outcome; Fluorouracil; Humans; Leucovorin; Male; Organoplatinum Compounds; Pulmonary Alveoli; Respiratory Insufficiency

Thrombotic microangiopathy occurs in 5-10% of patients with mucin-producing disseminated adenocarcinoma. A 28-year-old woman complained of fatigue, bone pain, and weight loss. There were pallor, icterus, and tenderness in the bones on physical examination. Microangiopathic hemolytic anemia, leukoerythroblastic picture, thrombocytopenia, and normal coagulation tests were detected. Thrombotic thrombocytopenic purpura (TTP) was diagnosed and therapeutic plasma exchange was performed on the patient. On day 5 a laparotomy had to be performed because of acute abdomen due to the rupture of a corpus hemorrhagicum follicle of an ovary. Signet ring cell adenocarcinoma stained with cytokeratin 7 and mucicarmine was seen on ovaries and bone marrow, after the pathological examination. The primary site of tumor could not be investigated, because of the patient's refusal. Although chemotherapy including cis-platinum, infusional 5-fluorouracil, and calcium leucovorin were administered in two courses, she died from respiratory failure. In conclusion, malignancy and bone marrow involvement should be considered when associated with leukoerythroblastic picture and TTP.

Topics: Abdomen, Acute; Adenocarcinoma, Mucinous; Adult; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Bone Marrow Neoplasms; Carcinoma, Signet Ring Cell; Cisplatin; Fatal Outcome; Female; Fluorouracil; Hemoperitoneum; Humans; Laparotomy; Leucovorin; Neoplasms, Unknown Primary; Ovarian Neoplasms; Plasma Exchange; Purpura, Thrombotic Thrombocytopenic; Respiratory Insufficiency

Progressive respiratory failure developed in a 68 year-old female who was treated with single-agent oxaliplatin for colorectal cancer. Only one cycle of 5-fluorouracil had been previously administered. Computed tomography of the chest showed lesions that suggested pulmonary fibrosis. There was an unfavourable response to treatment with corticosteroids, antimicrobial and antifungical agents. Lung biopsy findings were compatible with interstitial pneumonitis. The patient died 20 days after admission due to irreversible respiratory failure. This is the first case reported in the literature of interstitial pneumonitis related to single-agent oxaliplatin administration.

Topics: Adenocarcinoma; Aged; Antimetabolites, Antineoplastic; Antineoplastic Agents, Alkylating; Chemotherapy, Adjuvant; Colectomy; Colonic Neoplasms; Combined Modality Therapy; Fatal Outcome; Female; Fluorouracil; Gastrointestinal Diseases; Humans; Leucovorin; Lung Diseases, Interstitial; Organoplatinum Compounds; Oxaliplatin; Prednisone; Respiration, Artificial; Respiratory Insufficiency

Topics: Antifungal Agents; Drug Combinations; Glucuronates; Humans; Immunologic Deficiency Syndromes; Infant; Infusions, Intravenous; Leucovorin; Male; Pentamidine; Pneumonia, Pneumocystis; Quinazolines; Respiratory Insufficiency; Trimethoprim, Sulfamethoxazole Drug Combination; Trimetrexate