Department of Obstetrics and Gynecology, Shizuoka General Hospital, 4-27-1, Kita-Ando, Shizuoka City, Shizuoka, 420-8527, Japan.
Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Drugs R D. 2022 Dec;22(4):263-269. doi: 10.1007/s40268-022-00399-y. Epub 2022 Aug 20.
Irinotecan sometimes causes lethal septic shock but the risk factors remain unclear. This retrospective case-control study explored the potential risk factors for septic shock following irinotecan treatment.
All women who received irinotecan-containing chemotherapy for gynecologic malignancies at Shizuoka General Hospital from October 2014 to September 2020 were investigated. The clinical backgrounds and blood test results of those who developed septic shock after irinotecan-containing chemotherapy were compared with those who did not. Odds ratios (ORs) for developing septic shock after receiving irinotecan were calculated with 95% confidence intervals (CIs), using univariable logistic regression analysis.
During the study period, 147 women received irinotecan-containing chemotherapy. Three women developed septic shock due to neutropenic enterocolitis after irinotecan treatment, and 144 did not. The three patients with septic shock had recurrent cervical cancer, heterozygous variants in the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene (two patients had *1/*6, one had *1/*28 variants), a history of concurrent chemoradiation therapy, 50-60 Gy of pelvic irradiation, and platinum-combined chemotherapy. A history of pelvic irradiation was identified as a possible risk factor for developing septic shock after irinotecan-containing chemotherapy (OR 63.0, 95% CI 5.71-8635; p < 0.001). The OR of UGT1A1 polymorphism for septic shock was 9.09 (95% CI 0.86-1233; p = 0.070) in the complete case analysis.
Medical personnel involved in cancer therapy should consider the possible risk of septic shock developing due to neutropenic enterocolitis when administering irinotecan-containing chemotherapy in patients with a history of pelvic irradiation.
伊立替康有时会引起致命性感染性休克，但风险因素尚不清楚。本回顾性病例对照研究旨在探讨伊立替康治疗后发生感染性休克的潜在危险因素。
本研究纳入 2014 年 10 月至 2020 年 9 月在静冈综合医院接受含伊立替康化疗的妇科恶性肿瘤患者。比较发生伊立替康化疗后感染性休克患者与未发生感染性休克患者的临床背景和血液检查结果。采用单变量逻辑回归分析计算发生伊立替康化疗后感染性休克的比值比（OR）及其 95%置信区间（CI）。
研究期间，147 例患者接受了含伊立替康的化疗。3 例患者在伊立替康治疗后因中性粒细胞减少性肠炎并发感染性休克，144 例患者未发生感染性休克。3 例感染性休克患者均为复发性宫颈癌，均携带 UGT1A1 基因杂合变异（2 例为*1/6，1 例为1/*28 变异），有同期放化疗史、50-60 Gy 盆腔放疗和铂类联合化疗史。盆腔放疗史被认为是含伊立替康化疗后发生感染性休克的可能危险因素（OR 63.0，95%CI 5.71-8635；p<0.001）。在完全病例分析中，UGT1A1 多态性与感染性休克的 OR 为 9.09（95%CI 0.86-1233；p=0.070）。
在对有盆腔放疗史的患者进行含伊立替康化疗时，医务人员应考虑因中性粒细胞减少性肠炎导致感染性休克的可能风险。
