title: Acute cerebral arterial embolism following pemetrexed and carboplatin treatment in non-small-cell lung cancer: A case report.
abstract: Thromboembolism is a known vascular toxicity associated with tumor chemotherapy. The combination of pemetrexed and carboplatin has exhibited significant antitumor activity, with mild manageable toxicity in patients with advanced non-small-cell lung cancer (NSCLC), whereas cerebral arterial embolism has not been recognized as a side effect associated with this regimen. This is the case report of an unusual case of NSCLC, in which the patient suffered a left middle cerebral arterial embolism following chemotherapy. A 62-year-old non-smoking woman, diagnosed with stage IV lung adenocarcinoma, was administered pemetrexed and carboplatin as second-line therapy. On the day of the completion of the first regime cycle, the patient was readmitted to the emergency department with complaints of sudden-onset right hemiplegia and agitation. Brain magnetic resonance imaging and magnetic resonance angiography revealed an occlusion of the left middle cerebral artery (MCA) and no further chemotherapy was administered due to the deterioration in the performance status of the patient associated with right hemiplegia. Pemetrexed plus carboplatin is routinely used for the treatment of advanced NSCLC. The present case highlights the potential risk for development of embolism following pemetrexed-based chemotherapy. Further investigations are required to elucidate the mechanism through which these drugs may eventually cause neurovascular adverse events. Clinicians should be aware of the potential risk for development of cerebral arterial embolism following pemetrexed-based chemotherapy.
authors.affiliation: Department of Medical Oncology, Kishiwada City Hospital, Kishiwada, Osaka 596-8501, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Takeda
authors.affiliation: Department of Respirology, Kishiwada City Hospital, Kishiwada, Osaka 596-8501, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Respirology, Kishiwada City Hospital, Kishiwada, Osaka 596-8501, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Marumo
authors.affiliation: Department of Respirology, Kishiwada City Hospital, Kishiwada, Osaka 596-8501, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Koshimo
authors.affiliation: Department of Respirology, Kishiwada City Hospital, Kishiwada, Osaka 596-8501, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Teranishi
authors.affiliation: Department of Respirology, Kishiwada City Hospital, Kishiwada, Osaka 596-8501, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Higami
authors.affiliation: Department of Respirology, Kishiwada City Hospital, Kishiwada, Osaka 596-8501, Japan.
authors.forename: Motokazu
authors.initials: M
authors.lastname: Kato
keywords: cerebral arterial embolism; chemotherapy; non-small-cell lung cancer