Kuo J C, Parakh S, Yip D
Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia.
J Clin Pharm Ther. 2014 Aug;39(4):446-8. doi: 10.1111/jcpt.12160. Epub 2014 Apr 7.
Regorafenib improves progression-free survival as a late-line treatment for patients with metastatic gastrointestinal stromal tumour (GIST). As a multitargeted tyrosine kinase inhibitor (TKI), the expected adverse events of regorafenib are similar to those reported with imatinib, sunitinib or sorafenib. We report the first case of hyperammonemic encephalopathy related to regorafenib in a patient with metastatic GIST.
A 61-year-old man maintained on regorafenib for metastatic GIST presented with acute confusion. Discontinuation of regorafenib led to complete resolution of confusion, which later recurred with hyperammonemia on recommencing regorafenib. Cessation of regorafenib and normalization of hyperammonemia then resulted in resolution of confusion.
Regorafenib withdrawal and recommencement had influenced the confusional state and hyperammonemia in this patient. There is a probable relationship between regorafenib and metabolic encephalopathy. There are case reports of similar encephalopathy thought to be induced by other multitargeted TKI, and, as such, a class effect could be postulated.
瑞戈非尼作为转移性胃肠道间质瘤（GIST）患者的晚期治疗药物，可改善无进展生存期。作为一种多靶点酪氨酸激酶抑制剂（TKI），瑞戈非尼预期的不良事件与伊马替尼、舒尼替尼或索拉非尼报道的相似。我们报告了首例转移性GIST患者中与瑞戈非尼相关的高氨血症性脑病病例。
一名61岁男性因转移性GIST接受瑞戈非尼治疗，出现急性意识模糊。停用瑞戈非尼后意识模糊完全缓解，但再次开始使用瑞戈非尼时高氨血症复发，意识模糊随之再次出现。停用瑞戈非尼并使高氨血症恢复正常后，意识模糊得以缓解。
在该患者中，停用和重新使用瑞戈非尼影响了意识模糊状态和高氨血症。瑞戈非尼与代谢性脑病之间可能存在关联。有病例报告称其他多靶点TKI也可诱发类似的脑病，因此可以推测存在类效应。
