04 April 2023: Articles
Recurrent Reversible Stroke-Like Encephalopathy After 5-Fluorouracil (5-FU) Chemotherapy: A Case Report and Literature Review
Unusual clinical course, Mistake in diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Unexpected drug reaction, Clinical situation which can not be reproduced for ethical reasons
Kurniawan Agung Yuwono A , Susanna Hilda Hutajulu A , Abdul Gofir B , Dhite Bayu Nugroho B*DOI: 10.12659/AJCR.938437
Am J Case Rep 2023; 24:e938437
Table 3. Cases of encephalopathy associated with the administration of 5-FU.
| Reference | Author | Patient | Regimen (5-FU dose) | Clinical manifestation of encephalopathy | Level ammonia |
|---|---|---|---|---|---|
| []9 | Kim, 2006 | 68-year old male with anal cancer | 5-FU (1000 mg/m, continuous infusion, D1-5) and cisplatin (70 mg/m, 2-h infusion, D1), repeated every 4 weeks | Fifth day, second cycle | 354 mg/dl (0–64) |
| []11 | Yi, 2016 | 59-year old female stage IIb rectal cancer | FOLFOX4 (5FU 400 mg/m2 bolus and 600 mg/m continuous infusion for 22 hours day 1 and 2) | Third day, first cycle | 629 µg/dL (normal range, ∼75 µg/dL) |
| []12 | Nguyen, 2017 | 63-year old male stage III colon cancer | mFOLFOX6 (5-FU 400 mg/m IV bolus and 5-FU 2400 mg/m 46 h infusion) | Second day, first cycle | N/A |
| []13 | Mitani, 2017 | 8 of 1175 patient with GI or primary unknown cancer | 5FU based regimen | Median onset 3 day (range 2–21 day), 27,3% first cycle, 72,7% ≥2 cycles | N/A |
| []14 | Boilève, 2019 | 36-year old female with Gastrointestinal cancer of unknown primary | FOLFIRINOX (oxaliplatin, irinotecan, leucovorin, 5FU) -bevacizumab protocol | Within 48 hours after initiation of 5-FU infusion, first cycle | 593 µmol/l (normal 10–35 µmol/l) |
| []15 | Ihoriya, 2018 | 64-year old male with pT3N1M0 stage IIIa colon cancer | 5-FU/folinic acid and oxaliplatin at doses of 1.5 g/m, 75 mg/m, and 85 mg/m222 | N/A | 338 μg/dL (30–86 μg/dL) |
| []16 | Naik, 2020 | 43-year old female with adenocarcinoma of colon | FOLFOXIRI (irinotecan 165 mg/m, oxaliplatin 85 mg/m, folinic acid 400 mg/m, and 5-FU 400 mg/m bolus on day 1, followed by 5-FU 3200 mg/m by continuous infusion over the next 46 hours) | Third day, first cycle | N/A |
| []4 | Boilève, 2020 | 30 patients (73% GI tumor, 20% head and neck cancer, 7% breast cancer) | FOLFOX (5-FU oxaliplatin leucovorin); FOLFOX (5-FU; leucovorin; oxaliplatin; FOLFIRI (5-FU, irinotecan; leucovorin); LV5-FU (5-FU; leucovorin) FEC, (5-FU; epirubicin; cyclophosphamide) FLOT (5-FU; oxaliplatin; docetaxel) | Mean: 2 day | Mean 229 umol/L (range 86–378 umol/L) |