Paraneoplastic Necrotizing Myopathy Post Lumpectomy and Chemotherapy for Early Breast Cancer

Venkatesh, Priyanka; Hitchcock, Sophia M; Jacobsohn, Jamie A.; Kasi, Anup

doi:10.7759/cureus.10916

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…Daunomycin (or daunorubicin) is a cytotoxic anthracycline antibiotic that is often used in combination therapy for treatment of acute myelocytic leukemia (AML), acute lymphoblastic leukemia (ALL), neuroblastoma, and rhabdomyosarcoma [ 1 ]. Discovered over 50 years ago, daunomycin is an produced naturally by Streptomyces peucetius , a species of actinobacteria [ 2 ]. Daunomycin imparts its effects by DNA intercalation through a thermodynamically favorable process.…”

Section: Background and Importancementioning

confidence: 99%

“…Dose-dependent neurotoxic effects of doxorubicin have been demonstrated, however, and is thought to occur by impairment of long-term potentiation, induction of apoptosis, and increased superoxide production and lipid peroxidation [ 5 , 6 ]. While anthracycline administration is typically performed intravenously, doxorubicin is thought to accumulate within the CNS in cancer patients due to reduced blood-brain barrier integrity given an upregulation in pro-inflammatory cytokines [ 2 , 5 ].…”

Section: Background and Importancementioning

confidence: 99%

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Inadvertent intrathecal administration of daunomycin resulting in fatality: Case report and therapeutic considerations

et al. 2021

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Background Daunomycin is a chemotherapeutic agent of the anthracycline family that is administered intravenously, most commonly in combination therapy. The authors report the first known adult case of inadvertently administered daunomycin directly into the human central nervous system and the neurologic manifestations and therapeutic interventions that followed. Clinical description A 53-year-old male presenting to the hospital for his second cycle of consolidation therapy for acute promyelocytic leukemia t(15;17) was accidentally administered 93 mg of intrathecal (IT) daunomycin. Within several hours of injection, the patient subsequently developed bilateral lower extremity pain, ascending paresthesias, headache, and left cranial nerve (CN) III palsy. Immediately following these neurologic sequalae, a subarachnoid lumbar drain was placed at the L4-5 interspace for the initial irrigation and drainage of cerebrospinal fluid (CSF). By hospital day 2, the patient's mental status significantly declined requiring an external ventricular drain (EVD) for hydrocephalus. Despite therapeutic interventions, the patient developed an ascending radiculomyeloencephalopathy with deterioration in clinical status. Eighteen days after the inadvertent injection of IT daunomycin, the patient became comatose and lost all cranial nerve function. Conclusions Accidental IT injection of daunomycin is a neurosurgical emergency and warrants prompt intervention. Symptoms can mimic other medical conditions, making it imperative an accurate diagnosis is made so that appropriate therapies are implemented. At this time, therapies include rapid removal of the chemotherapeutic agent from the IT compartment by aspiration and irrigation; however, it is unclear if neuroprotective agents may provide added benefit.

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Section: Background and Importancementioning

confidence: 99%

Section: Background and Importancementioning

confidence: 99%

Inadvertent intrathecal administration of daunomycin resulting in fatality: Case report and therapeutic considerations

et al. 2021

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“…Later on, several newer ANTs have been developed to treat multiple types of cancers ( Bonfante et al, 1980 ; McGowan et al, 2017 ). Although ANTs have been successful in treating a variety of cancers, they have been associated with both acute and chronic cardiotoxicity, depending on the cumulative dose of each agent ( Table 1 ) ( Venkatesh and Kasi, 2019 ; Rocca et al, 2020 ). For example, early adverse effects of DOX have been reported to reduce the left ventricular ejection fraction within months post-treatment with a cumulative dose ≥350 mg/g 2 ( Buzdar et al, 1985 ).…”

Section: Introductionmentioning

confidence: 99%

The beneficial role of exercise in preventing doxorubicin-induced cardiotoxicity

Gaytan

Lawan²,

Nurunnabi³

et al. 2023

Front. Physiol.

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Doxorubicin is a highly effective chemotherapeutic agent widely used to treat a variety of cancers. However, the clinical application of doxorubicin is limited due to its adverse effects on several tissues. One of the most serious side effects of doxorubicin is cardiotoxicity, which results in life-threatening heart damage, leading to reduced cancer treatment success and survival rate. Doxorubicin-induced cardiotoxicity results from cellular toxicity, including increased oxidative stress, apoptosis, and activated proteolytic systems. Exercise training has emerged as a non-pharmacological intervention to prevent cardiotoxicity during and after chemotherapy. Exercise training stimulates numerous physiological adaptations in the heart that promote cardioprotective effects against doxorubicin-induced cardiotoxicity. Understanding the mechanisms responsible for exercise-induced cardioprotection is important to develop therapeutic approaches for cancer patients and survivors. In this report, we review the cardiotoxic effects of doxorubicin and discuss the current understanding of exercise-induced cardioprotection in hearts from doxorubicin-treated animals.

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“…Since their discovery, these agents have been used to treat a number of cancers with curative intent. Although effective, anthracyclines are the primary cause of chemotherapy induced cardiotoxicity whose mechanism remains only partially understood with free radical formation an important contributor 6,7 . In 2014, Top2β was shown to be the key mediator of anthracycline induced cardiomyocyte apoptosis and deletion of Top2β prevented defective mitochondrial biogenesis and reactive oxygen species formation ultimately protecting cardiomyocytes 8 .…”

Section: Introductionmentioning

confidence: 99%

The efficacy and toxicity of dexrazoxane use in children with cancer: A pupulation-based study from Maritimes, Canada

Cruickshank¹

2023

DMJ

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Anthracycline induced cardiotoxicity is a well-recognized complication in pediatric oncology. The use of the cardio-protective drug dexrazoxane has gained traction despite its unclear efficacy and toxicity. A retrospective, population-based study was completed using chart and database information on children treated with anthracycline at the IWK Health Centre from 2009-2015 (n=178). The efficacy of dexrazoxane was defined as a lack of undesirable deviations in identified cardiac parameters on echocardiogram. Toxicity of dexrazoxane was defined as chemotherapy delays from any of decreased absolute neutrophil count (ANC), decreased platelets, increase in viral/bacterial episodes and febrile neutropenia (FN) episodes. Patients were stratified into groups based on the total amount of anthracycline received and whether they received dexrazoxane. Regardless of anthracycline dose, we found no significant relationships regarding cardiac function in the untreated and dexrazoxane treated groups. However, we found that patients who were treated with >250mg/m2 of anthracycline and received dexrazoxane experienced significantly more platelet delays but no cardiac benefit (p=0.007). When classified by diagnosis, we also found that dexrazoxane treated patients diagnosed with low-risk acute lymphocytic leukemia (LR-ALL) were likely to experience a delay in treatment due to both low ANC (p=0.0001) and the development of FN (p=0.02) whereas high-risk acute lymphocytic leukemia (HR-ALL) patients were likely to experience treatment delays due to thrombocytopenia (p=0.03), low ANC (p=0.0001) and FN (p=0.0001). Despite finding no significant differences regarding the efficacy of dexrazoxane as a cardio-protectant, we have shown that its use induces non-cardiac toxicities in children with cancer that contribute to treatment delays.

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Paraneoplastic Necrotizing Myopathy Post Lumpectomy and Chemotherapy for Early Breast Cancer

Cited by 5 publications

References 19 publications

Inadvertent intrathecal administration of daunomycin resulting in fatality: Case report and therapeutic considerations

Inadvertent intrathecal administration of daunomycin resulting in fatality: Case report and therapeutic considerations

The beneficial role of exercise in preventing doxorubicin-induced cardiotoxicity

The efficacy and toxicity of dexrazoxane use in children with cancer: A pupulation-based study from Maritimes, Canada

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