Acute encephalopathy following arsenic trioxide for metastatic urothelial carcinoma.
There have been no prior reports of central nervous system toxicity following arsenic trioxide in patients with solid tumors. We report three metastatic urothelial carcinoma patients who were treated with arsenic trioxide (0.24 mg/kg/d 3-hour intravenously on days 1-6 weekly for 4 of every 5 weeks) who developed a clinical symptom complex characterized by confusion, word-finding difficulty, and behavioral changes. These symptoms appeared between day 26 and day 45 and resolved spontaneously in 1 patient. Two patients' symptoms did not resolve and they died of progressive urothelial carcinoma on days 47 and 90, respectively. Neuroimaging, lumbar puncture, and laboratory investigations did not reveal other causes. Arsenic trioxide in this dose and schedule can cause acute encephalopathy in patients with metastatic urothelial carcinoma who have received previous chemotherapy.
Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
Chia-Chi
CC
Lin
Yeong-Shiau
YS
Pu
Chih-Hung
CH
Hsu
Hsiao-Yi
HY
Keng
Ann-Lii
AL
Cheng
Chih-Hsin
CH
Yang
D000208:Acute Disease; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000009:adverse effects*; D001927:Brain Diseases / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010087:Oxides / Q000009:adverse effects*; D013832:Thiamine Deficiency / Q000150:complications; D014516:Ureteral Neoplasms / Q000188:drug therapy* / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology
D000970:Antineoplastic Agents; D001152:Arsenicals; D010087:Oxides; D000077237:Arsenic Trioxide