Separate episodes of capillary leak syndrome and pulmonary hypertension after adjuvant gemcitabine and three years later after nab-paclitaxel for metastatic disease

详细信息    查看全文

• 作者：Andrea Casadei Gardini (1)
  Michele Aquilina (1)
  Devil Oboldi (1)
  Alessandro Lucchesi (1)
  Silvia Carloni (1)
  Elena Tenti (1)
  Marco Angelo Burgio (1)
  Dino Amadori (1)
  Giovanni Luca Frassineti (1)
  
• 关键词：Capillary leak syndrome ; Chemotherapy ; Gemcitabine ; Nab ; paclitaxel ; Abraxane ; Pulmonary hypertension
• 刊名：BMC Cancer
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：13
• 期：1
• 全文大小：748 KB
• 参考文献：1. Carmichael J, Fink U, Russell RC, Spittle MF, Harris AL, Spiessi G, Blatter J: Phase II study of gemcitabine in patients with advanced pancreatic cancer. / Br J Cancer 1996, 73:101-05. CrossRef
  2. Abbratt RP, Bezwoda WR, Falkson G, Goedhals L, Hacking D, Rugg TA: Efficacy and safety profile of gemcitabine in non-smallcell lung cancer: a phase II study. / J Clin Oncol 1994, 12:1535-540.
  3. Coskun U, Günel N, Yildirim Y: Gemcitabine induced pulmonary injury. / Case Rep Pract Rev 2004, 5:178-79.
  4. Remuzzi G, Schieppati A, Ruggenenti P, Bertani T: Thrombotic thrombocytopenia purpura, hemolytic uremic syndrome, and acute cortical necrosis. In / Diseases of the Kidney. 5th edition. Edited by: Schrier RW, Gottschalk CW. Boston: Little, Brown and Company; 1993:2063-094.
  5. Hosein PJ, Jr G , Pastorini VH, Gomez C, Macintyre J, Zayas G, Reis I, Montero AJ, Merchan JR, Rocha Lima CM: A phase II trial of nab-Paclitaxel as second-line therapy in patients with advanced pancreatic cancer. / J Clin Oncol 2013, 36:151-56. CrossRef
  6. Aapro MS, Martin C, Hatty S: Gemcitabine - a safety review. / Anticancer Drugs 1998, 9:191-01. CrossRef
  7. Briasoulis E, Pavlidis N: Noncardiogenic pulmonary edema: an unusual and serious complication of anticancer therapy. / Oncologist 2001, 6:153-61. CrossRef
  8. Pavlakis N, Bell DR, Millward MJ: Fatal pulmonary toxicity resulting from treatment with gemcitabine. / Cancer 1997, 80:286-91. CrossRef
  9. Ciotti R, Belotti G, Facchi E, Cantù A, D’Amico A, Gatti C: Sudden cardio-pulmonary toxicity following a single infusion of gemcitabine. / Ann Oncol 1999, 10:997. CrossRef
  10. de Pas T, Curigliano G, Franceschelli L, Catania C, Spaggiari L, de Braud F: Gemcitabine-induced systemic capillary leak syndrome. / Ann Oncol 2001, 12:1651-652. CrossRef
  11. Pulkkanen K, Kataja V, Johansson R: Systemic capillary leak syndrome resulting from gemcitabine treatment in renal cell carcinoma: a case report. / J Chemother 2003, 15:287-89.
  12. Nelson BK: Snake envenomation. Incidence, clinical presentation and management. / Med Toxicol Adverse Drug Exp 1989, 4:17-1. CrossRef
  13. Luce JM: Pathogenesis and management of septic shock. / Chest 1987, 91:883-88. CrossRef
  14. Parrillo JE, Parker MM, Natanson C, Parrillo JE, Parker MM: Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction and therapy. / Ann Intern Med 1990, 113:227-42. CrossRef
  15. Chang AE, Rosenberg SA: Overview of interleukin-2 as an immunotherapeutic agent. / Semin Surg Oncol 1989, 5:385-90. CrossRef
  16. Semb KA, Aamdal S, Oian P: Capillary protein leak syndrome appears to explain fluid retention in cancer patients who receive docetaxel treatment. / J Clin Oncol 1998, 16:3426-432.
  17. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2407/13/542/prepub
  
• 作者单位：Andrea Casadei Gardini (1)
  Michele Aquilina (1)
  Devil Oboldi (1)
  Alessandro Lucchesi (1)
  Silvia Carloni (1)
  Elena Tenti (1)
  Marco Angelo Burgio (1)
  Dino Amadori (1)
  Giovanni Luca Frassineti (1)
  
  1. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014, Meldola, FC, Italy
  
• ISSN：1471-2407

文摘

Background Systemic capillary leak syndrome is a rare disease with a high mortality rate. This syndrome is characterised by generalised edema, hypotension, hemoconcentration, and hypoproteinemia. The cause is the sudden onset of capillary hyperpermeability with extravasations of plasma from the intravascular to the extravascular compartment. We present the case of a patient who experienced two episodes of systemic capillary leak syndrome and pulmonary hypertension; the first after gemcitabine in an adjuvant setting and the second three years later after treatment with nab-paclitaxel for metastatic disease. Case presentation A 65-year-old patient underwent a pancreatectomy in January 2010 for ductal carcinoma (pT3 N0 M0, stage IIa), followed by adjuvant chemotherapy. Seven days after the last cycle, she developed dyspnea associated with orthopnea and cough. A transthoracic cardiac ecocolordoppler was performed, with evidence of pulmonary hypertension (58?mmHg). Blood tests showed an increase in creatinine, pro-BNP and D-Dimer. She began high-dose diuretic therapy combined with cortisone. After a month, the patient was eupneic and the anasarca had resolved. We decided gradually to reduce the steroid and diuretic therapy. After ten days of the reduction, the patient began to re-present the same symptoms after treatment with gemcitabine. Corticosteroid therapy was restored with rapid clinical benefit and decreased pro-BNP after a week of treatment. After two years, the disease returned. As a first line treatment, it was decided to use nab-paclitaxel 100?mg/m2 weekly. After two doses, followed by approximately 14?days of treatment, the patient developed acute respiratory distress syndrome. The clinical suspicion was a relapse of capillary leak syndrome and treatment with a high-dose diuretic (furosemide 250?mg daily) was started combined with cortisone (40?mg methylprednisolone). The patient showed a progressive clinical benefit. Conclusions In patients treated with gemcitabine and nab-paclitaxel who experience a sudden onset of diffuse edema with respiratory distress, capillary leak syndrome should be suspected. Immediate treatment with corticosteroids may be life-saving.