Jarkowski Anthony
Hematology/Oncology, Department of Pharmacy, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Am J Health Syst Pharm. 2008 Dec 1;65(23):2229-31. doi: 10.2146/ajhp080069.
A case of ifosfamide-induced neurotoxicity after the addition of aprepitant to an antiemetic regimen is reported.
A 24-year-old white man diagnosed with a malignant peripheral nerve sheath tumor initially in the late 1990s was admitted to the hospital for treatment of a recurrence of the tumor in the supra-clavicular region. In the previous five cycles of ifosfamide, carboplatin, and etoposide, the patient had no problems with the neurotoxic adverse effects associated with ifosfamide use. With the fifth cycle of therapy, the patient suffered severe nausea and vomiting that required his readmission to the hospital. With the initiation of the sixth cycle of chemotherapy, aprepitant was added to the existing antiemetic regimen of ondansetron and dexamethasone. During the sixth cycle, approximately six hours after the infusion of ifosfamide on day 3, the patient exhibited the classic symptoms of ifosfamide-induced neurotoxicity, including visual and auditory hallucinations, obvious sleepiness, confusion, and delirium. Since his symptoms resolved by morning, it was determined that the patient did not require treatment with methylene blue. With the initiation of the seventh cycle of chemotherapy, aprepitant was again added to the standard antiemetic regimen of a corticosteroid and serotonin receptor antagonist. During this hospitalization, around-the-clock methylene blue was added to prevent neurotoxicity. The patient tolerated chemotherapy well without any signs or symptoms of neurotoxicity and was discharged four days later.
A 24-year-old patient treated with ifosfamide, carboplatin, and etoposide for a malignant peripheral nerve sheath tumor developed ifosfamide-induced neurotoxicity after the addition of aprepitant to a standard antiemetic regimen consisting of ondansetron and dexamethasone.
报告1例在止吐方案中加用阿瑞匹坦后出现异环磷酰胺诱导的神经毒性的病例。
一名24岁白人男性，20世纪90年代末初诊为恶性外周神经鞘瘤，因锁骨上区肿瘤复发入院治疗。在前五个周期的异环磷酰胺、卡铂和依托泊苷治疗中，患者未出现与使用异环磷酰胺相关的神经毒性不良反应。在第五周期治疗时，患者出现严重恶心和呕吐，需要再次入院。在开始第六周期化疗时，在现有的昂丹司琼和地塞米松止吐方案中加用了阿瑞匹坦。在第六周期，第3天输注异环磷酰胺约6小时后，患者出现了异环磷酰胺诱导的神经毒性的典型症状，包括视幻觉和听幻觉、明显嗜睡、意识模糊和谵妄。由于其症状在早晨缓解，确定患者不需要亚甲蓝治疗。在开始第七周期化疗时，阿瑞匹坦再次被添加到由皮质类固醇和5-羟色胺受体拮抗剂组成的标准止吐方案中。在此次住院期间，加用了全天候的亚甲蓝以预防神经毒性。患者化疗耐受良好，未出现任何神经毒性的体征或症状，4天后出院。
一名接受异环磷酰胺、卡铂和依托泊苷治疗恶性外周神经鞘瘤的24岁患者，在由昂丹司琼和地塞米松组成的标准止吐方案中加用阿瑞匹坦后出现了异环磷酰胺诱导的神经毒性。
