title: Rapid tumor lysis syndrome in a patient with metastatic colon cancer as a complication of treatment with 5-fluorouracil/leucoverin and irinotecan.
abstract: Tumor lysis syndrome is a potentially fatal complication of anti-cancer therapy that is usually seen in patients with bulky, rapidly proliferating, treatment-sensitive tumors such as hematological malignancies, but it rarely occurs in a variety of solid tumors such as colorectal carcinoma. Combination chemotherapy with infusional 5-fluorouracil/leucoverin and irinotecan has been recently accepted as the first treatment option for metastatic colorectal cancer. We present a case of tumor lysis syndrome in a patient with metastatic colon carcinoma that occurred 72 hrs after the initial course of a combination chemotherapy with irinotecan and 5-fluorouracil/leucoverin. Despite the immediate treatment with aggressive hydration by a sodium bicarbonate infusion, followed by forced diuresis and uricolytic therapy, he died of a sudden cardiac arrest complicated by acute renal failure. Our case indicates that administration of 5-fluorouracil/leucoverin and irinotecan for bulky tumors of colorectal origin with a rapid doubling time may induce an acute tumor lysis syndrome, which necessitates frequent laboratory monitoring and a close follow-up of the patient as well as prompt initiation of appropriate therapeutic measures.
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey. ilhan.oztop@deu.edu.tr
authors.forename: Ilhan
authors.initials: I
authors.lastname: Oztop
authors.forename: Binnaz
authors.initials: B
authors.lastname: Demirkan
authors.forename: Arzu
authors.initials: A
authors.lastname: Yaren
authors.forename: Oktay
authors.initials: O
authors.lastname: Tarhan
authors.forename: Bulent
authors.initials: B
authors.lastname: Sengul
authors.forename: Cagnur
authors.initials: C
authors.lastname: Ulukus
authors.forename: Davut
authors.initials: D
authors.lastname: Akin
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sen
authors.forename: Ugur
authors.initials: U
authors.lastname: Yilmaz
authors.forename: Mehmet
authors.initials: M
authors.lastname: Alakavuklar
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000556:secondary; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002166:Camptothecin / Q000009:adverse effects / Q000031:analogs & derivatives*; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017809:Fatal Outcome; D005472:Fluorouracil / Q000009:adverse effects; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000009:adverse effects; D008297:Male; D015275:Tumor Lysis Syndrome / Q000209:etiology* / Q000628:therapy
chemical_list: D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin