Severe Generalized Weakness, Paralysis, and Aphasia following Administration of Irinotecan and Oxaliplatin during FOLFIRINOX Chemotherapy

Chandar, Manisha; Marsh, Robert de Wilton

doi:10.1159/000380849

Cited by 12 publications

(18 citation statements)

References 9 publications

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“…To date, 29 cases of transient dysarthria and/ or aphasia observed during or shortly following the administration of irinotecan have been reported in the literature and are summarized in Table 1 [12][13][14][15][16][17][18][19][20][21]27].…”

Section: Discussionmentioning

confidence: 99%

“…In all reported cases [12][13][14][15][16][17][18][19][20][21], clinical signs were stable and neurological examinations showed no evidence of neurological abnormalities, except dysarthria. Patients were monitored carefully and observed to return close to their baseline status within 1-2 h.…”

Section: Discussionmentioning

confidence: 99%

“…Co-administration of atropine 0.2 mg administered subcutaneously may prevent these adverse reactions. Some central nervous system (CNS) adverse events related to CPT-11 have also been described, including dysarthria and/or aphasia, and to date only 29 cases have been reported in the literature [12][13][14][15][16][17][18][19][20][21]27] (Table 1). The mechanism of CPT-11-related neurological toxicity is not completely understood.…”

Section: Introductionmentioning

confidence: 99%

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Irinotecan-Induced Transient Dysarthria: Case Series and Updated Literature Review

et al. 2020

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Irinotecan-based regimens are used worldwide for the treatment of several recurrent or advanced gastrointestinal malignancies. In this paper we describe the cases of four patients treated in our institution who developed acute dysarthria while receiving intravenous infusion of irinotecan. In all our cases, dysarthria occurred during the infusion of the first course of irinotecan, and then resolved rapidly without any sequelae. Imaging of the brain was performed, but failed to show any evidence of an acute neurological event. We also reviewed the literature on this very uncommon adverse event. The pathogenesis of irinotecan-induced dysarthria is still unknown and is not completely elucidated by the current pharmacodynamic or kinetic explanations; therefore, we could only hypothesize some assumptions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Irinotecan-Induced Transient Dysarthria: Case Series and Updated Literature Review

et al. 2020

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“…Chandar et al [22] reported a case of a 67-year-old woman with newly diagnosed metastatic pancreatic adenocarcinoma who was treated with FOLFIRINOX. During her first infusion of irinotecan, she developed acute onset of generalised weakness, paralysis of all extremities and nonfluent aphasia with a complete inability to communicate.…”

Section: Discussionmentioning

confidence: 99%

Acute Peripheral Motor Neuropathy Induced by Oxaliplatin-Correlated Hypokalaemia

et al. 2019

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Neurotoxicity is one of the most common side effects of oxaliplatin-based therapy. Most patients who receive at least 3-4 months of treatment suffer from peripheral sensory neurotoxicity (PSN), characterised by the loss or impairment of tactile and proprioceptive sensory function. Motor impairment, such as muscle weakness or palsy, has been rarely described, and the physiopathology of PSN, as well as the motor symptoms due to oxaliplatinbased treatment, are not adequately understood. Here we report the case of a patient who experienced severe acute peripheral motor neuropathy as a side effect of oxaliplatin-based treatment. We also review other cases of PSN published in the literature and suggest a novel hypothesis on the physiopathology of this particular event. Takeaway lessons: Not all of the neurological symptoms observed during oxaliplatin-based treatment can be traced back directly to the oxaliplatin itself, and other factors, such as electrolyte imbalances, may contribute to the symptoms. Patients with gastrointestinal malignancies are the patients most affected by neurotoxicity due to the side effects of chemotherapy and the disease itself.

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“…MRI is commonly performed but rarely yields additional information. The measures described in the literature to alleviate this symptomatology are shown in Table 1 [8,9,11,[14][15][16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Temporary Dysarthria Induced by Irinotecan-Case Report of This Rare Adverse Event

Landgraf¹,

Bognar²,

Guerra³

et al. 2017

JPP

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Abstract:This report describes the case of a patient with dysarthria during the administration of the third cycle of Folfiri for the treatment of metastatic colon cancer. After a thorough neurological examination and neuroimaging, structural causes were excluded and thus the dysarthria was attributed to the irinotecan infusion. A slowing down of the infusion rate to 180 min during the 15 subsequent cycles led to the cessation of the episodes of dysarthria. In 2016, it was estimated there will be 134,490 new cases of colorectal cancer with a five-year survival rate of 21% among patients with metastatic disease. As Irinotecan is often part of the therapeutic regimen in such cases, both in the first and second-line setting, there is a need to report rare adverse outcomes in order to find out ways to better manage of these events. The mechanism by which Irinotecan causes dysarthria is unknown and further research in this area is warranted.

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Severe Generalized Weakness, Paralysis, and Aphasia following Administration of Irinotecan and Oxaliplatin during FOLFIRINOX Chemotherapy

Cited by 12 publications

References 9 publications

Irinotecan-Induced Transient Dysarthria: Case Series and Updated Literature Review

Irinotecan-Induced Transient Dysarthria: Case Series and Updated Literature Review

Acute Peripheral Motor Neuropathy Induced by Oxaliplatin-Correlated Hypokalaemia

Temporary Dysarthria Induced by Irinotecan-Case Report of This Rare Adverse Event

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