Sorafenib
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Fatal tumour lysis syndrome: case report A 55-year-old man developed tumour lysis syndrome (TLS) and subsequently died from multiple organ failure and metabolic acidosis during treatment with sorafenib for hepatocellular carcinoma (HCC). The man, who had hepatitis B virus infection and a solid tumour, started treatment with oral sorafenib 400mg twice daily, furosemide and spironolactone. Thirty days later, his urine output was decreased and he had general weakness and profound jaundice (total bilirubin 344 µmol/L). Further tests revealed the following; creatinine 177 µmol/L, BUN 34 mmol/L, serum sodium 112 mmol/L, potassium 7 mmol/L, ammonia 92 µmol/L, AST 698 U/L, ALT 297 U/L. He was diagnosed with acute renal failure with hyperkalaemia. The man was treated with oral calcium polystyrene sulfonate and IV calcium gluconate, sodium bicarbonate, glucose water with insulin and corticosteroids. Liver failure secondary to exacerbation of hepatitis B virus infection was suspected and he was treated with entecavir. The following day, he had a serum potassium level of 7.2 mmol/L and sorafenib was discontinued. He received emergency haemodialysis. His serum potassium level normalised the following day. At that time, his other laboratory parameters were as follows; sodium 128 mmol/L, uric acid 547 µmol/L, creatinine 248 µmol/L. Sorafenib was restarted at half his original dose, his diuretics were discontinued and he received saline for suspected dehydration. Further tests revealed that his potassium level had normalised, his uric acid level was 851 µmol/L, his phosphorous level was 5.4 mmol/L and his creatinine level was 309 µmol/L. Sorafenib was discontinued due to suspicion of TLS. He received allopurinol and a further course of emergency haemodialysis. His general condition stabilised. However, multiple organ failure and metabolic acidosis persisted and, despite further haemodialysis, he died 13 days after admission. Author comment: "The prognosis of TLS is poor with a high mortality rate in solid tumor . . . [I]n the therapy of HCC with sorafenib, especially in patients with high tumor burden and showing a good initial response, the possible occurrence of TLS should be kept in mind and appropriate laboratory data should be monitored." Huang W.-S., et al. Sorafenib induced tumor lysis syndrome in an advanced hepatocellular carcinoma patient. World Journal of Gastroenterology 15: 4464-4466, No. 35, 2009. Available from: URL: http://dx.doi.org/10.3748/ 803007139 wjg.15.4464 - Taiwan
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Reactions 13 Mar 2010 No. 1292
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