Saito Yoshitaka, Takekuma Yoh, Furuta Megumi, Sugawara Mitsuru
Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan.
Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
Case Rep Oncol. 2021 Oct 4;14(3):1418-1421. doi: 10.1159/000518776. eCollection 2021 Sep-Dec.
Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most serious adverse effects of chemotherapy. We experienced carboplatin (CBDCA)-induced akathisia-like CIPN, which was significantly attenuated by pregabalin administration, and report its treatment. A man in his 40s was administered CBDCA + pemetrexed (PEM) as the third-line treatment for recurrent malignant pleural mesothelioma. He rarely experienced mild akathisia-like symptoms on his feet before the diagnosis. The patient claimed that he exhibited mild degradation of the symptoms in the previous cisplatin (CDDP) + PEM treatment without the need for pharmacotherapy. Symptoms notably worsened approximately 7 days after the first cycle of CBDCA + PEM and did not disappear. Furthermore, symptoms worsened during the daytime and became milder at night. Lorazepam (0.5 mg) was administered 3 times a day from day 14 but was not effective. Finally, we evaluated the symptoms to be derived from CBDCA-induced neuropathy as he experienced the same symptoms in CDDP + PEM and did not have suspicious pathology or medicines for akathisia development. We decided to administer 75 mg pregabalin twice daily, resulting in significant symptom improvement. He also complained that he felt the symptoms 10 h after the previous pregabalin dose, suggesting that pregabalin was effective, and its effect weakened or disappeared as time progressed. Akathisia-like symptoms caused by CBDCA-induced CIPN are rare, but they significantly reduce the quality of life. Pregabalin was significantly effective in this case; therefore, we suggest that a detailed symptom interview and selection of the medicine, based upon the action mechanism, are necessary.
化疗引起的周围神经病变（CIPN）是化疗最严重的不良反应之一。我们遇到了卡铂（CBDCA）引起的静坐不能样CIPN，给予普瑞巴林后症状明显减轻，并报告其治疗情况。一名40多岁的男性接受CBDCA +培美曲塞（PEM）作为复发性恶性胸膜间皮瘤的三线治疗。在诊断前，他很少在足部出现轻度静坐不能样症状。患者称，在之前的顺铂（CDDP）+ PEM治疗中，症状有轻度减轻，无需药物治疗。在CBDCA + PEM的第一个周期后约7天，症状明显加重且未消失。此外，症状在白天加重，夜间减轻。从第14天开始，每天3次给予劳拉西泮（0.5mg），但无效。最后，由于患者在CDDP + PEM治疗中出现相同症状，且没有可疑的病理或导致静坐不能的药物，我们评估症状是由CBDCA引起的神经病变所致。我们决定每天两次给予75mg普瑞巴林，症状明显改善。他还抱怨说，在上次服用普瑞巴林10小时后仍能感觉到症状，这表明普瑞巴林有效，但其效果会随着时间的推移而减弱或消失。CBDCA引起的CIPN导致的静坐不能样症状很少见，但会显著降低生活质量。普瑞巴林在本病例中显著有效；因此，我们建议进行详细的症状问诊，并根据作用机制选择药物是必要的。
