Spontaneous tumor lysis syndrome in a giant neglected breast cancer.

Cordrey, Evan O; Dienhart, Jason A; Wang, Jue

doi:10.35841/molecular-oncology.2.2.38-41

Cited by 3 publications

(7 citation statements)

References 18 publications

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“…Time-to-TLS is an important consideration for deciding when these patients need to be monitored. Our patient was in frank TLS just 6 days following the first infusion, but a wide range of timing has been described in case reports (2–33 days [18]). The timeframe in which TLS should be monitored for is made further unclear due to the delayed onset of response with immunotherapy, which may be months after treatment initiation.…”

Section: Discussionmentioning

confidence: 89%

Tumor Lysis Syndrome following a Single Dose of Nivolumab for Relapsed Small-Cell Lung Cancer

2021

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Tumor lysis syndrome (TLS) is an oncologic emergency most frequently associated with initial treatment of hematologic malignancies and high-tumor burden solid tumors such as small-cell lung cancer (SCLC). Most often, TLS is associated with cytotoxic chemotherapy. In the treatment of SCLC, a paradigm shift has taken place in which immunotherapy is often added to chemotherapy for extensive-stage disease in the frontline setting or as monotherapy in the relapsed setting. Nivolumab is a programmed death 1 receptor blocking antibody previously FDA indicated for the treatment of metastatic SCLC with progression after platinum-based chemotherapy and at least one other line of therapy. Nivolumab, like all immune checkpoint inhibitor therapies, is associated with immune-mediated adverse reactions; however, there are few reported cases of nivolumab-induced TLS. We present a case of nivolumab-induced TLS following a single infusion. An 86-year-old female with a history of widely metastatic SCLC with metastasis to the liver, bone, and lymph nodes presented to the hospital following a fall due to weakness, dizziness, slurred speech, nausea, vomiting, and abdominal pain occurring 6 days after receiving her first nivolumab infusion. After extensive evaluation, the patient was diagnosed with TLS with hyperkalemia, acute renal failure, hyperphosphatemia, and hypocalcemia. She was treated aggressively with intravenous fluids, rasburicase, and sodium polystyrene sulfate (Kayexalate<sup>®</sup>), which resulted in rapid improvement of her electrolytes and renal function. However, despite correction of electrolytes and overall symptomatic improvement, over the course of several days, the patient’s condition rapidly deteriorated with increasing dyspnea, lethargy, confusion, and eventually death. TLS following nivolumab is exceedingly rare. This report highlights the potential risk of development of TLS with checkpoint inhibitor therapy.

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Section: Discussionmentioning

confidence: 89%

Tumor Lysis Syndrome following a Single Dose of Nivolumab for Relapsed Small-Cell Lung Cancer

2021

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“…Since then, there has been a total of only 133 cases of TLS in solid tumors, with 33 of them occurring spontaneously [5-7]. Of these, STLS occurred in four cases of breast cancer [6-9].…”

Section: Discussionmentioning

confidence: 99%

You Can’t Always Blame the Chemo: A Rare Case of Spontaneous Tumor Lysis Syndrome in a Patient with Invasive Ductal Cell Carcinoma of the Breast

Parsi

Rai

Clay

2019

Cureus

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Tumor lysis syndrome (TLS) is an oncologic emergency characterized by metabolic and electrolyte abnormalities, observed during the destruction of tumor cells. While it is commonly seen during cytotoxic treatment of hematologic malignancies, it is rarely seen or suspected in solid tumors. The incidence of spontaneous tumor lysis (before cancer treatment) in solid malignancies is even rarer. Herein, we present the case of a spontaneous tumor lysis syndrome (STLS) in a woman who presented with chest pain and was found to have metastatic ductal cell carcinoma of the breast. She presented with acute renal failure and demonstrated all laboratory derangements consistent with TLS, despite not being on chemotherapy. Fortunately, her clinical status improved with prompt treatment, but the long-term effects of TLS can be fatal if not recognized and managed immediately. This case highlights that early recognition and appropriate treatment can be lifesaving. Furthermore, it demonstrates the importance of maintaining a high clinical suspicion in all patients with malignancy, whether hematologic or solid, of the possibility of TLS, even in the absence of chemotherapy.

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“…However, our recent study shows significant increase in cases of TLS associated with solid tumors [4]. TLS occurs in essentially every tumor type, such that the tumor burden itself is likely the more important factor than the tissue origin or location [3][4][5][6][7]. High tumor burden has classically been defined via three concrete measurements: bulky disease (>10 cm), elevated LDH (>2x upper limit of normal), and elevated WBC (>25,000) [9].…”

Section: Discussionmentioning

confidence: 99%

“…RCC is the most common solid lesion of the kidney, and more than 40% of patients eventually die from this disease. Although the true incidence of TLS in RCC is difficult to assess, we postulate that TLS in RCC may be underdiagnosed and underreported [3][4][5][6][7]. Several studies showed that a substantial proportion of TLS cases presenting to the emergency department (ED) were not recognized as such.…”

Section: Discussionmentioning

confidence: 99%

“…The most important finding from our study is that TLS associated with RCC occurs later than previously expected: the median time from treatment to TLS was 16 days with a range of 14 to 28 days. This finding is particularly important because it is outside the usual timeframe that is observed with conventional chemotherapy in routine clinical setting [4][5][6][7]. The current guidelines and consensus on diagnosis and management of TLS were based on pediatric hematologic tumors and established more than one decade ago [8][9].…”

Section: Discussionmentioning

confidence: 99%

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Tumor lysis syndrome associated with renal cell carcinoma

2019

Int Med

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Background: Tumor lysis syndrome (TLS) is an oncologic emergency which has been extensively documented in patients with hematological malignancies, but rarely described in patients with renal cell carcinoma (RCC). The objective of this study was to investigate the clinical characteristics and outcomes of TLS, a rare but life-threatening complication in RCC. Methods: Retrospective literature review and pooled analysis. Results: Ten cases of TLS were identified in patients with metastatic RCC (eight cases in published literature and two cases from our tumor registry). The median age of patients was 60 years (45-88). Seven cases (70%) of TLS were associated with a variety of treatment regimens, include sunitinib (42%), pazopanib (14.2%), nivolumab (14.2%), nivolumab and Ipilimumab (14.2%), and temsirolimus (14.2%). The median time to TLS from treatment 16 days (14-28). Three (33%) patients had spontaneous TLS. All patients had extensive metastatic disease at the time of presentation, with visceral metastases documented in 100% of TLS cases. The majority of cases were clear renal carcinoma (one case of sarcomatoid, and another with extensive rhabdoid feature). All cases were treated with aggressive supportive measures, and four patients received rasburicase. The mortality rate was 57% among seven cases of treatment related TLS. The mortality rate was 100% in the three patients with spontaneous TLS. Conclusions: TLS in RCC can occur both after treatment and spontaneously, and is associated with very high mortality. Our findings underscore the importance of heightened awareness, risk assessment, and early prevention of this previously underdiagnosed oncologic emergency.

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Spontaneous tumor lysis syndrome in a giant neglected breast cancer.

Cited by 3 publications

References 18 publications

Tumor Lysis Syndrome following a Single Dose of Nivolumab for Relapsed Small-Cell Lung Cancer

Tumor Lysis Syndrome following a Single Dose of Nivolumab for Relapsed Small-Cell Lung Cancer

You Can’t Always Blame the Chemo: A Rare Case of Spontaneous Tumor Lysis Syndrome in a Patient with Invasive Ductal Cell Carcinoma of the Breast

Tumor lysis syndrome associated with renal cell carcinoma

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